Teacher input form for a special education evaluation
By the IEP Atlas editorial teamLast updated
Short answer
A teacher input form tells the evaluation team how the student performs in class compared with peers. Fill in current skills by subject with numbers, attach scored work samples, describe behavior and attention with counts, list what you have tried and how it worked, and name the student's strengths. Specific, dated data is what makes the form useful.
When a student is referred for a special education evaluation, the school psychologist or case manager usually sends the classroom teacher a form. It asks what the student does in class. Your answers become part of the evaluation report, and often part of the student's present levels if the student is found eligible.
The regulations name teacher observations and classroom-based assessments as data the team must review.[1] The evaluation must draw on a variety of sources, and your form is one of the main ones.[2] It carries weight because you see the student every day, across subjects, next to 25 classmates. For a learning disability decision, the student's regular teacher is also a required member of the eligibility group.[3]
Fill-in teacher input form
Copy the prompts. Write numbers wherever you can. Districts use their own forms, so match yours to these sections if they differ.
1. Student and teacher
- Student: ________ Grade: ____ Date: ________
- Teacher and subject(s): ________ Time with this student per day: ________
2. Your main concern
- In two or three sentences, what worries you and when did you first notice it? ________
3. Current performance by subject For each subject, give the student's level, the class or grade expectation and a data point.
- Reading: ________
- Writing: ________
- Math: ________
- Other subjects: ________
- Latest screening or benchmark scores, with dates: ________
4. Work samples
- Attach 2 or 3 recent samples, scored, with the date and how much help was given: ________
5. Behavior, attention and work habits
- What you see, how often and when (give counts or estimates with a time frame): ________
- What happens right before and after: ________
- Compared with classmates: ________
6. Communication and social skills
- Following directions, expressing ideas, peer interaction: ________
7. Motor skills
- Handwriting, use of tools, moving around the room: ________
8. What you have tried
| Strategy or intervention | Dates | How often | Result |
|---|---|---|---|
| ________ | ________ | ________ | ________ |
9. Strengths and interests
- At least three specific strengths: ________
10. Attendance and parent contact
- Absences and tardies this year: ________
- Parent contacts and what was discussed: ________
11. Questions you want the evaluation to answer
- ________
Completed example: a fourth grader
The example is fictional. It shows the level of detail that helps an evaluation team.
1. Student and teacher. Sofia R., grade 4, October 20, 2026. Ms. Chen, general education, all core subjects, about 5 hours a day.
2. Main concern. Sofia writes far less than classmates and avoids starting written work. I noticed it in the first week of school. Her spoken ideas are strong, but they rarely make it onto paper.
3. Current performance.
- Reading: on grade level. 112 words correct per minute on a grade 4 passage on September 15; answers comprehension questions accurately aloud.
- Writing: in a 3-minute timed write on October 6, she wrote 14 words with 9 correct word sequences. Class median was 38 words. Paragraphs have 1 or 2 sentences; most classmates write 5 or more.
- Math: computation accurate (18 of 20 on the unit test). Word problems: correct when read aloud, but she often skips writing an explanation.
- Science and social studies: participates orally; written responses incomplete on 7 of 10 assignments since September.
- Fall screening (September 12): reading at benchmark; writing below benchmark.
4. Work samples. Attached: a September 30 narrative (3 sentences in 25 minutes, no prompts); an October 8 science response (one sentence, after two reminders); a math test showing correct answers with no written work.
5. Behavior and work habits. During 20-minute writing blocks, she sharpens pencils, asks to use the restroom or erases repeatedly in most sessions. I counted 4 to 6 off-task episodes per block over 5 blocks. She is on task and engaged during discussion and math. Classmates average 1 or 2 such episodes.
6. Communication and social. Follows multi-step oral directions. Explains ideas clearly in discussion. Has two close friends; plays well at recess.
7. Motor. Grips the pencil tightly, presses hard, and says her hand hurts after about 5 minutes. Letters vary in size. Cuts and builds with materials without trouble.
8. What I have tried.
| Strategy or intervention | Dates | How often | Result |
|---|---|---|---|
| Graphic organizer for planning | Sept 8 to now | Every writing task | Plans orally well; written output still 1 to 3 sentences |
| Sentence starters | Sept 15 to now | Daily | Writes 1 more sentence on average |
| Dictating to a peer or adult | Oct 1 to now | 2 to 3 times a week | Dictated responses average 6 sentences |
| Small-group writing with the interventionist | Sept 22 to now | 20 minutes, 3 days a week | Correct word sequences rose from 6 to 9 in 4 weeks |
9. Strengths. Strong vocabulary, excellent oral storyteller, accurate in math computation, kind to classmates, loves drawing comics.
10. Attendance and parent contact. 2 absences, no tardies. Spoke with her mother on September 18 and October 9; she sees the same avoidance with homework.
11. Questions. Is something making the physical act of writing hard? Is there a gap between what she knows and what she can get down in writing? What supports would help her show her knowledge?
What the evaluation team looks for in each section
| Section | What makes it useful | What weakens it |
|---|---|---|
| Main concern | A specific skill and when it shows up | "Struggles in all areas" |
| Current performance | Student's score next to the class or grade expectation | Grades alone, or a grade equivalent |
| Work samples | Dated, scored, with the help level noted | Unscored samples with no context |
| Behavior | Counts or estimates with a time frame, plus what happens before and after | "Always off task" |
| What you have tried | Dates, frequency and a result for each | A list of strategies with no results |
| Strengths | Specific and usable in instruction | "Sweet kid" |
| Questions | Ones the evaluation can answer | None listed |
Parents read this form too, because it is quoted in the report. Write as if they are reading over your shoulder: honest, specific and fair.
Tips for filling it out quickly
- Use data you already have. Screening scores, unit tests and intervention probes count. A one-minute curriculum-based measurement probe is enough for a fresh data point.
- Count one behavior for a week. Tally marks on a sticky note during one block a day give a real number. The frequency data sheet works if you want a printed sheet.
- Score the work samples the same way. For writing, count total words and correct word sequences. For math, record correct out of attempted on the accuracy data sheet.
- Separate accommodations from interventions. Extra time is an accommodation. A small group with weekly probes is an intervention.
Due dates
The evaluation deadline runs from the date the school received the parent's consent. Ask the case manager for the date, or enter it in the IEP due date calculator to see the deadline. Return your form within the first two weeks so the evaluators can use it to plan testing and the observation. The classroom observation guide shows what the observer will record in your room.
For the parent side of the paperwork, see consent for evaluation and the parent input form. The full process is in the IEP evaluation process.
Frequently asked questions
How long should a teacher input form take to complete?
About 30 to 45 minutes if you already have screening data and work samples. Most of the time goes into pulling numbers together. A week of tally counts on the main behavior makes the form much stronger.
Can parents see what I write on the teacher input form?
Yes. It becomes part of the student's education record, and it is often quoted in the evaluation report the parent receives. Write factually and include strengths.
What if I have only had the student for a few weeks?
Say so on the form and report what you have. Ask the previous teacher for input and check last year's records, report cards and screening scores.
Use it in IEP Atlas
- Evaluation in the IEP glossary
- Reevaluation in the IEP glossary
- IEP due date calculator
- Frequency data sheet
- Work sample in the IEP glossary
Related guides
- The IEP evaluation process: from referral to eligibility
- Classroom observation for an evaluation: what to record
- Consent for evaluation: what you are signing
- How to request a special education evaluation in writing (sample letter)
- Parent input form for the IEP
Sources
- 34 CFR §300.305: Additional requirements for evaluations and reevaluations, U.S. Department of Education (IDEA website)
- 34 CFR §300.304: Evaluation procedures, U.S. Department of Education (IDEA website)
- 34 CFR §300.308: Additional group members, U.S. Department of Education (IDEA website)
Written and checked by the IEP Atlas editorial team under our editorial policy. This guide describes general practice and federal rules. It is not legal advice; your state may add requirements, and the IEP team makes the decisions for each student.