Ready For Life Academy – Student Performance Summary
To be completed by the school district Educational Specialist or Transition Coordinator
1
Student: ____________________________________________School phone ____________________________
Date ____________________________ How long have you known this individual? _____________________
Disability ____________________________________________________________________________________
School name __________________________________ Evaluator name________________________________
Evaluator title__________________________________ Evaluator signature_____________________________
ReadyForLife
Performance Summary
Communication:
Expresses needs and wants
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Receptive language
 Understands what was spoken
 Independently managed
 Needed information/instruction repeated
 Not observed
 Understands little spoken word
Expressive language
Clarity of speech
 Easily understood
 Understood after a short time of interaction
 Difficult to understand
Comments:
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Volume of speech
 Good levels
 Too loud
 Too soft
Comments:
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Tone of speech
 Acceptable levels
 Abrasive levels
 Piercing levels
Comments:
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Verbal directions/instructions
 Remembers 1 step
 Remembers 2-3 steps
 Remembers 4 or more steps
Comments:
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Written directions/instructions
 Follows 1 step
 Follows 2-3 steps
 Follows 4 or more steps
 Needs Pictures
Comments:
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1
Focus and Attention
2
Concentrating on meaningful activity student needs: (please check box on each row that applies)
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term assistance
 Long term assistance
 Independently managed
 Medication intervention necessary
If concentration is difficult how is the inattention manifested?
□Hyperactivity
□Hypo-activity
□Drawing into self or state of daydream
What activity is the focus?
________________________________________________________________________________________________
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How long was meaningful attention achieved? ____________min. at a time
Comments:
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Tolerating environment (sounds, light, crowds, etc.)
 No noticeable issues
 Some noticeable issues
What are the issues?
 Multiple noticeable issues
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Educational/Intellectual Performance
General level of functioning needed
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Reading level
 Not able to read
 Elementary Level __________grade
 Middle School level ____________grade
 High school level ____________grade
 Special equipment needed
 Not Observed
Comments:
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Comprehension level
 Elementary level __________grade
 Middle school level ____________grade
 High school level __________grade
 Not Observed
Comments:
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2
3
Writing level
 Not able to write
 Elementary level ___________grade
 Middle school level ____________grade
 High school level ____________grade
 Special equipment needed (computer, etc.)  Not Observed
Comments:
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Writing
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Legibility
 Easily read
 Read with effort
 Un-legible
 Not Observed
Comments:
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Can write in:
 Words
 Short sentences
 Complex sentences  Paragraphs  Papers
 Not Observed
Comments:
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Thinking functions:
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Concrete language (words describing things one can see, handle, smell, hear and taste)
 Understands basic words and language
 Concrete language skills very limited
 Not Observed
Comments:
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Abstract concepts (sportsmanship, pride, imagination, freedom, etc.)
 Understands abstract concepts
 Abstract language skills very limited
 Not Observed
Comments:
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Process concepts (digestion, combustion, long distance, solar energy, Google, etc.)
 Understands process language
 Process language skills very limited
 Not Observed
Comments:
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Critical Thinking/Problem Solving
 Can compare and contrast information
 Takes information literally
 Can observe and evaluate
 Not Observed
Comments:
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Comments:
3
4
Sustain expected performance level
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Comments:
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Computer use and manipulation
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Comments:
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Interest and/or ability in (check all that apply):
 Art
 Singing
 Sports
 Health dynamics
 Drama
 Sciences
 Politics
 Psychology
 Dance


 Engineering
 Instrument: What kind?________________________________
 Computers
 Philosophy
 Education
 Not observed
 Social Work
 Religion
 College Paper
Home educational work (evenings after RFL hours – check all that apply)
 1 on 1 (constant) support/instruction needed to complete
 Desires homework
 Not Observed
 Needs detailed instruction to compete properly
 Uses too much energy at RFL to have homework
Comments:
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College Class Attendance (attending an actual college class as a guest – check all that apply)
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Trained staff mentor
 College student in class mentor
 College student out of class mentor
 Independently managed
 Expresses interest in attending
 Not recommended
Comments:
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Behavioral Attention and Thinking
Response to instructive feedback
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Positive response
 Indifferent or ignoring response
 Negative response
 Independently takes action to bring about change
 Unable to initiate change independently
Comments:
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4
5
Positive choice making
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Makes positive choices regularly
 Makes positive choices occasionally  Makes positive choices infrequently
 Independently problem solves to make positive choices
 Able to preview consequences before making choices
Comments:
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Learns from consequences
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Understands relationship between consequences and behavior change
 Consequences have little or no effect on behavior
 Not observed
What consequences serve as a motivator for behavior change?
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Monitors own behavior
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Comments:
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Demonstrates problem solving techniques
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Recognizes the problem
 Previews outcome of problem
 Determines value of solving problem
 Determines source of problem
 Weighs options to solve problem
 Takes action to correct problem
 Evaluates effectiveness of solution  Understands lesson learned
 Not observed
Comments:
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Follows the rules and instructions given
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Rarely follows the rules and instructions independently
 Regularly follows rules and instructions independently
 Needs reminders to follow the rules and instructions given
 Not observed
Comments:
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Demonstrates behavior appropriate for a college setting
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Maturational level needs growth
 Appropriate boundaries may be an issue for instruction
 Demonstrates desire to “fit in” with other college students
 Not observed
Comments:
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5
Personal/Social
6
Manages personal time
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Understands time with a clock or watch  Does not have a sense of time  Could manage time with a timer
 Manages computer calendar
 independently managed
 Not observed
Comments:
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Manages personal belongings
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Has an order and system that is effective
 Has no order or system for organization
 Could benefit from instruction for a personal organizational system
 Independently manages his/her belongings
 Not observed
Comments:
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Finds his/her way around campus
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Navigates independently
 Needs repeated instruction for mastery
 Safety would be in question
 Not observed
Comments:
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Interacts appropriately with other RFL students
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Demonstrates desire to build relationships
 Responds positively to instruction for relationship building
 Understands appropriate relationship boundaries  Not observed
Comments:
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Interacts appropriately with college students
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Demonstrates desire to build relationships
 Responds positively to instruction for relationship building
 Understands appropriate relationship boundaries  Not observed
Comments:
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Interacts appropriately in a group setting
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Demonstrates desire to build relationships
 Responds positively to instruction for relationship building
 Understands appropriate relationship boundaries  Not observed
Comments:
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6
7
Interacts appropriately in a one-on-one setting
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Demonstrates desire to build relationships
 Responds positively to instruction for relationship building
 Understands appropriate relationship boundaries  Not observed
Comments:
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Exhibits proper “personal space”
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Too close to people
 Inappropriate boundaries demonstrated
 Bristles at touch
 Demonstrates appropriate boundaries
 Not observed
Comments:
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Exercises proper humor
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Good and appropriate sense of humor demonstrated  Has difficulty understanding humor
 Laughs at appropriate times
 Has difficulty with timing of laughter
 Has difficulty with volume of laughter
 Not observed
Comments:
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Is polite and respectful of peers and staff
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Comments:
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Be trusted with independence
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Reported when requested
 Needs behavior modification incentives to promote independence
 Demonstrated ability to be independent and responsible
 Not observed
Comments:
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Are there mobility issues?
 No
 Yes – please describe:
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7
8
Personal Care Assistance
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
 Independently managed
 Not observed
Comments:
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Personal Hygiene
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Demonstrates good personal hygiene
 Demonstrates poor personal hygiene in the following areas:
 Hair care
 Body cleanliness
 Nose care
 Clean clothing
 Feminine hygiene
 Tooth care
 Health prevention (hand washing)
 Breath
 Not observed
Comments:
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What level of support do you see this individual generally needing if enrolled in RFL
 1 on 1 (constant) support/instruction  1 on 4 (moderate) support/instruction  1 on 6 (minimal) support/instruction
 Short term
 Long term
Concern areas:
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Strength areas:
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8