Counselor Classroom Observation Form
Student Observation Form
School Counseling & Student Support Services
Confidential
Single-Session Record
Student Name
Grade / Room
Date
Time / Duration
Teacher / Subject
Observer
Class Setting
□ Whole Class □ Small Group □ Independent □ Transition
1. Engagement & Classroom Participation
Quick check observed behaviors
□ On-task / focused □ Starts work promptly □ Volunteers / contributes □ Easily distracted □ Fidgety / restless □ Off-task / disengaged
2. Learning Behaviors & Persistence
Work habits & response to challenge
□ Organized materials □ Follows directions □ Appropriately asks for help □ Persists through challenge □ Gives up / shuts down □ Rushes / incomplete
3. Social-Emotional Skills & Self-Regulation
Affect, peer interactions & coping
□ Calm & regulated □ Positive peer interactions □ Uses coping strategies □ Anxious / guarded □ Frustrated / irritable □ Withdrawn / isolated
Observed Strengths & Assets
Concerns & Next Steps
□ 1:1 Counseling □ Teacher Consult □ Caregiver Contact □ SST / 504 Follow-up
Observer Signature:
Date:
Confidential Counseling Protocol
