1. Sample Eval Data
      1. 1. Teacher/Staff Observation
      2. 2. Medical Records
      3. 3. Assessment
      4. 4. Family Input
      5. 5. Other

    Sample Eval Data



    1. Teacher/Staff Observation

    · ELA Teacher (Mr. Ramirez): Kim frequently leaves her seat during class without permission and needs repeated redirection to return to tasks. She struggles to follow multi-step directions and often turns in incomplete assignments. Despite these challenges, she demonstrates strong verbal reasoning skills during class discussions when engaged.
    · School Counselor Note: Kim appears restless during group guidance sessions and fidgets with objects. She is aware of her behavior and has expressed frustration about "trying hard but always getting distracted."
     



    2. Medical Records

    · Pediatrician Diagnosis (Dr. A. Feldman, Pediatric Associates of Snohomish): ADHD, Combined Presentation, diagnosed at age 8. Most recent follow-up (March 2025) notes continued difficulties with focus and hyperactivity, despite behavioral strategies and consistent home routines. Kim is currently taking a low dose of methylphenidate (Concerta 18mg daily).
    · Additional Note: No significant co-occurring conditions reported. Sleep and appetite are within normal ranges with medication.
     



    3. Assessment

    · BASC-3 Behavior Rating Scales (Completed by Teacher and Parent, February 2025):
    o Teacher Report: Clinically significant elevations in Attention Problems (T-score: 76) and Hyperactivity (T-score: 71).
    o Parent Report: Elevated scores in Executive Functioning and Adaptability.
    · Academic Performance Data: Kim scores within the average range on district reading and math benchmarks but has 12 missing homework assignments across subjects and received two failing grades for Q2 due to incomplete work.
     



    4. Family Input

    · Parent Statement (504 Meeting Intake Form): "Kim has always been a bright, funny, and energetic kid. At home, she can focus when doing hands-on projects or things she’s passionate about, like building models or coding games. But schoolwork is harder—she forgets assignments, loses materials, and gets overwhelmed easily. We're seeing her self-esteem dip because she thinks she’s 'bad at school.' We hope the school can help her stay on track without feeling like she’s constantly in trouble."
     



    5. Other

    · Attendance Record: 5 tardies and 4 early dismissals in the last quarter, mostly due to slow morning routines and difficulty transitioning from home to school.
    · Discipline Log: Two office referrals this year for interrupting class and arguing with a peer when frustrated. No suspensions. Teachers report that consequences tend to escalate her frustration rather than reduce behaviors.
     

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