Class Visitation Checklist

Date: ___________________________________________ Time: _______________________________________ a.m./p.m.
School: ____________________________________________________________________________________________
Class: _____________________________________________________________________________________________

Student Description:

Total students: _____________________________________ Gender range: ______________________________________
Age range: __________________________________________________________________________________________
Cognitive range: ______________________________________________________________________________________
Language/communication range: _________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Disability range: ______________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Behavioral range: _____________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Other observations: ____________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Staff Description:

Teachers: ___________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Aides: ______________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Other observations: ____________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Curricula/Classroom Strategies:

Curricula: ____________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Strategies: ___________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Classroom Environment:

Description: __________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Related Services: _________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Other Comments: _________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

How This Program Relates to IEP Blueprint: _________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________