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| Name: | ________________________ | Date of Birth: | ________________________ |
| School: | ________________________ | Grade: | ________________________ |
| Attentional Abilities | Mostly | Sometimes | Never |
| Uses effective strategies to recall memory on short term | _______ | _______ | _______ |
| Uses effective strategies to recall memory on longer term | _______ | _______ | _______ |
| Knows how to apply and generalize a skill to a new situation | _______ | _______ | _______ |
| Knows when to apply and generalize a skill to a new situation | _______ | _______ | _______ |
| Makes effective use of lists | _______ | _______ | _______ |
| Understands explanations, directions and instructions and repeats in own words | _______ | _______ | _______ |
| Able to complete fill in the blank sentences with appropriate words | _______ | _______ | _______ |
| Highlights or summarizes information he/she should remember | _______ | _______ | _______ |
| Can remember the sequence of events of a story | _______ | _______ | _______ |
| Is able to use reference resources effectively | _______ | _______ | _______ |
| Can remember the steps in a procedure | _______ | _______ | _______ |
| Can remember and deliver a message to another teacher/school personnel | _______ | _______ | _______ |
| Comments |
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| Completed by: | ____________________________________________________________________ |
| Relationship to student: | ____________________________________________________________________ |
| Date: | ____________________________________________________________________ |
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Last update: September 1998 Branch Contact |