TEACHER QUESTIONNAIRE FOR PSYCHOLOGICAL ASSESSMENT
Confidential – To be completed by the child’s class teacher or relevant school staffPlease complete as fully as possible. This information is important to ensure a well-rounded understanding of the child’s needs in the school setting.
Section 1: General Information
1. Child's Full Name
2. Date of Birth
3. Current Class/ Year Group
4. School Name and Address
5. Your name:
6. Your role:
7. How long have you know the child/ worked with the child?
Section 2: Learning and Cognitive Profile
8. How would you describe the child’s general learning ability? (e.g., age-appropriate, delayed, advanced)
9. What are the child's strengths
10. Are there particular areas of challenge (e.g., reading, writing, maths, memory, attention)?
11. How does the child approach learning tasks (e.g., motivation, persistence, independence)?
12. Has the child had access to any specific teaching interventions or learning supports?
Section 3: Attention and Executive Functioning
13. Does the child have difficulty sustaining attention in class?
Never
Often
Sometimes
Always
14. Are there difficulties with (tick those that apply):
Following instructions
Finishing tasks
Organising materials/work?
Impulsivity or blurting out?
Waiting their turn
Section 4: Social and Emotional Development
15. How does the child interact with peers? (e.g., makes friends easily, prefers to play alone, difficulties in social understanding)
16. How does the child interact with adults?
17. Are there concerns about emotional wellbeing (e.g., anxiety, low mood, frequent distress)?
18. Have you noticed any behaviours that seem to cause stress or challenges at home, school, or in the community — like strong reactions, pulling away from others, or repeating certain actions?
19. How does the child typically respond to changes in routine?
Section 5: Communication and Language
20. Are there any observed differences in the child's:
Understanding of spoken language
Expressive language (vocabulary, grammar)?
Social communication (e.g., eye contact, conversation skills)?
Please describe any relevant observations:
Section 6: Sensory and Motor Profile
21. Does the child show sensitivity with:
Light
Noise
Touch
Crowds
22. Please describe any relevant observations:
23. Are there any differences in:
Balance
Coordination
Handwriting
Fine Motor
Section 7: Attendance and Participation
24. Has the child had significant absences from school? ☐ Yes ☐ No If yes, please provide details.
25. Does the child participate in group work, classroom discussions, or extracurricular activities?
Section 8: Support and Accommodations
26. Are they in receipt of Special Education Teaching (SET) or SNA support? If yes, please detail the nature of the support.
27. What strategies or accommodations have been most helpful in supporting the child?
Additional Comments
28. Are there any other observations or concerns that you feel are relevant to this assessment?
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Role
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Signature
Submit
Submit
Should be Empty: