Multi-Factored Evaluation

(Information including student name has been changed or removed to protect the students privacy)

Student Name: Raphael Costello

Date of Birth: **/**/****
Chronological Age: 16
Evaluator: Matthew D'Agostino
Title: Intervention Specialist
Student Interview Data:
Getting to Know You (Form 4.3): The student is asked to mark how they enjoy spending his/her
time, talents he/she has, strengths, any topics of interest he/she would like to learn more about,
the best way he/she learns and preferred classroom activities.
Raphael enjoys spending time on the computer, watching TV and playing videogames.
He also likes to spend his time with his family, listening to music and playing baseball.
Raphael stated that he considers his strengths to be optimism, loyalty, courage and honesty.
He often talks about videogames and YouTube and has expressed interest in making videogames,
drawings and the wild west.
Raphael learns best when the environment is quiet.
He prefers to work in groups (4-7 People) rather than alone.
He also learns best when activities are hands on and also through listening, discussion, and
writing things down.
Student Learning Survey: The student is asked to decide if a characteristic related to studying
and interests is like him/her or not.
When Raphael completed the learning survey he marked that he:
Enjoyed telling stories, needed to move and could not sit still ,needed quiet when he worked ,
needs to know the big picture, and enjoys drawing and creating. The student also expressed that
he is not great at planning, does not like writing and research, does not like teaching others, does
not like to record information in groups, and does not like choices on how to do things.

3-2-1 Biography Poem Template:

I am shy, loyal, and quirky.
I love videogames, family, and computers.
I learn best when everything around me is quiet.
My name is Raphael Costello

Reading and Writing Interest Inventory: The student is asked to reflect on his/her reading
interests and learning preferences and write his/her answers to a variety of questions.
In the Reading and Writing Interest Inventory, Raphael wrote that he was interested in reading
about video game design, he also wrote that he wanted to read about making movies especially
westerns, and zombie movies. He also likes genres such as action adventure, fiction, mystery,
and horror and he especially liked the Sherlock homes books and create your own adventure
books. Raphael Costello likes writing top 10 lists and, writing in a fancy way (cursive). Teachers
help Raphael the most when they slow down making sure he can comprehend a text that is being
read, and read over the text a second time. He appreciates it when teachers explain activities
more than once. One of his proudest moments was when he received a yellow belt in karate.
When people pick on Raphael it pushes his hot buttons.
Perception of Executive Functioning Strengths and Weaknesses
Executive Skills Questionnaire for Students (Form 2.5): The student is asked to rate themselves
between 1 (big problem) and 5 (no problem) on a variety of items related to their behavior, study
habits, and frustration on work tasks.
Response Inhibition: 9
Emotional Control: 8
Task Initiation: 7
Organization: 9
Flexibility: 7
Goal-Directed Persistence: 7
Working Memory: 11
Sustained Attention: 9
Planning: 8
Time Management: 10
Metacognition: 9
Relative Strengths: Working Memory, Response inhibition, and Time management
Relative Weaknesses: Task Initiation, Flexibility, and Goal- Directed Persistence
Curriculum Based Measurement
3-Minute Reading Assessment:
Raphael read a portion of an 8th grade passage with 100% accuracy.
During the reading Raphael mumbled and did not vary his tone.
Below are listed his scores from the assessment:
Fluency-Automaticity: 188 WCPM
Expression and volume: 2 out of 4 This means that Raphael begins to make text sound
like natural language in some areas but not in others. Raphael still reads in a quiet voice.
Phrasing and intonation: 3 out of 4 - Raphael reads with a mixture of run-ons, midsentence pauses, and some choppiness; reasonable stress and intonation.

Smoothness: 4 out of 4 Raphael generally reads smoothly and self corrects effectively.
Pace: 4 out of 4 Raphael reads at an appropriate rate throughout reading.
Total score = 13/16
Comprehension score = 4 out of 6 Raphael can recall the main idea and can provide
supporting details but these details are not necessarily organized logically or sequentially
as it is presented in the passage.

What critical needs are identified and targeted for intervention? Describe the goals of the
intervention.
Critical Needs:
Raphael needs to learn how to plan for both long term tasks and short term assignments.
He also has trouble with goal-directed persistence and has trouble seeing the long term plan.
Often times when he is given the chance to do a fun activity he will do the fun activity rather
than a homework assignment or project.
Raphael also has trouble starting tasks and puts off homework and responsibilities until the last
minute. Raphael needs any reminders to start assignments and long term tasks and finds it hard
to stay focused unless he is directed to do so.
Once Raphael has established a plan it is hard for him to deviate from his plan even if the first
solution does not work. He also has problems with open ended homework assignments and does
not know what to write about when given open ended writing prompts.
Raphael also has significant trouble with comprehension during reading and some trouble with
oral reading such as mumbling, expression, volume, and intonation.
Goals of the intervention:
Raphael will be able to independently plan for both long term and short term tasks.
Raphael will start tasks with less prompting and complete a significant amount of work before
switching to non-school related activities.
Raphael will stay on task with fewer prompts.
Raphael will become more flexible and will be able to think of alternate plans after the first does
not work.
Raphael will learn strategies to improve comprehension.
Raphael will improve expression, volume, intonation and overall fluency during oral reading.