Student Questionnaire – Teacher Assessment

Success Club Testimonial Form

    Please complete for each student you teach/are responsible for. Please name each student 'student 1, student 2 etc..




    Based on your professional opinion and using your prior knowledge of this student, please rate them on a scale of 1-4 where 1 is poor and 4 is excellent.

    Use the start of the Autumn term 2022 as your baseline.

    1. There is a noticeable improvement in the student’s behaviour.

    2. Student is less angry/anxious/aggressive/unhappy (dependant on the individual student’s behaviour patterns).

    3. Student is more engaged in school activities with an improved motivation to learn.

    4. Student’s confidence and/or self-esteem has increased.

    5. Student’s resilience/coping skills/ability to bounce back from difficulties have increased.

    6. Some or all of the student’s relationships with: peers/teachers/parents have improved.

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