Page 55 - 2016 Handbook FINAL 4.18.16

CULTURALLY AND LINGUISTICALLY DIVERSE GENERAL EDUCATION TEACHER QUESTIONNAIRE

Student: ______________________________Date: __________Teacher: _____________________

PLEASE ANSWER ALL QUESTIONS THAT PERTAIN TO THIS STUDENT

What are your major concerns with the student’s communication in the classroom?

Give examples of the concerns:

Are the child’s difficulties, the result of adaptation to a different culture in the classroom environment?
Yes No

Students in the beginning stage of learning another language may be in what is called the “silent
period.” How long has the student been exposed to the second language?

What language does the child feel comfortable using in social contexts?

What language does the child feel comfortable using in academic contexts? __

Has language dominance been determined? (From parents’ perspective, or bilingual staff’s
perspective?) _Yes _ _No Comments:

Does the child receive ESL support in the classroom? __ __ Yes ____ No

How has that support benefited the student’s learning in your classroom? ______________________

What other interventions measures have you tried? ________________________________________

Did the interventions work? How long has the intervention program been in place? ______________

Has the child participated in reading interventions? Yes _ No

How do the student’s communications skills compare with other student’s with his or her linguistic
background?

Does the child initiate verbal interactions with peers? __ Yes ____ No

Does the child initiate or organize play activities with peers? ____Yes No

Does the child demonstrate facial, eye contact, and gestures deemed culturally appropriate by peers?
____ Yes ____ No Describe:

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