Student ID * Level * K-2 3-5 6-12 Questions This student struggles to pay attention: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student has difficulty making and keeping friends: * Yes - he is a loner He talks to others but is not close to anyone Not really He seems to have friends He has close friends This student is overly influenced by peers: * Multiple times a day Almost daily Weekly Maybe once a month Rarely When upset, this student becomes belligerent and disrespectful: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student receives frequent behavior reprimands: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student exhibits poor personal hygiene: * Multiple times a day Almost daily Weekly Maybe once a month Rarely The student becomes physically or verbally aggressive: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student becomes easily angered and/or agitated: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student offends other students and/or educators with his words: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student gets in trouble with his friends: * Multiple times a day Almost daily Weekly Maybe once a month Rarely This student gets in trouble trying to please or get the attention of others: * Multiple times a day Almost daily Weekly Maybe once a month Rarely email2 To prevent automated spam submissions leave this field empty.Submit