Teacher input
Student information form template
A teacher form for recording support needs, peer considerations, and other details used during placement.
DOCX form
Download the student form
Download the blank, editable Word file without submitting an email address. Read the completed example on this page, then add your school details and save a working copy.
Download DOCXFile: shibutz-student-information-form.docx
Blank template structure
Completed example
Fictional completed example: a teacher records current observations for Student 01, a synthetic Grade 2 student moving to Grade 3. This is sample wording, not an assessment or a real student profile.
Collect only information needed for placement and the receiving teacher’s first steps. Use authorized school records for identities; leave out full histories, diagnostic documents, and family details that are not needed for this decision.
The download remains a blank, editable DOCX. This completed example is shown here for reference; it is not prefilled into the file.
Student details and placement signals
Student: Student 01. Current grade: Grade 2. Current teacher: current classroom teacher. Next-year program / track: Grade 3 general classroom. Primary language: not collected for this example. Review owner: grade-level coordinator.
- Reading / language arts
- Typical support. Starts independent reading after the teacher checks the first instruction; observed during four lessons this week.
- Math
- Typical support. Explains a worked example with a partner, then completes the next problem independently.
- Executive function
- High support. Needs a short written task list and an adult check-in to start multistep work.
- Social confidence
- Typical support. Joins paired work readily when roles are stated before the task.
- Emotional regulation
- Typical support. Returns to the task after a brief, agreed quiet break.
- Behavior support
- Typical support. Responds to the class reminder about turn-taking; no additional placement rule proposed.
- Independence
- High support for task starts. Review the morning check-in arrangement with the receiving teacher.
Peer considerations and teacher recommendation
Works well with: Student 02. During three paired reading tasks, both students took turns and completed the activity. Record this as a preference for review, not a promise. Prefer separate from: none proposed from current observations. Do not place with: no required separation submitted in this example.
A classroom with a predictable start-of-lesson routine would help Student 01 begin work. In the first two weeks, use the short written checklist and confirm who provides the check-in. Do not assume that a peer can provide that adult support.
Administrator review
Completed by: current classroom teacher, 10 June 2026. Admin reviewed: grade-level coordinator, 12 June 2026. Decision: retain the peer preference for the draft review and ask the support coordinator to confirm check-in coverage. Revisit after the first two weeks of term.
The DOCX is a staff input form, not a direct Shibutz import. Review its observations, then enter the relevant scores, preferences, or approved rules in the workspace. Free-text notes do not automatically become placement constraints.
Use teacher observations when checking the draft, including support arrangements that class averages do not capture. Review the resulting lists with the balance checklist.
- Best for
Teachers, counselors, and administrators
Teachers know details that are not visible in the SIS export. Counselors need a structured place for placement concerns. Your team wants consistent input before the placement meeting.
- Inside
What the file includes
Teacher observation prompts, Academic and social notes, Friend and separation considerations, Administrator review section
- Shibutz fit
How it connects to placement software
Use the form to collect staff observations, then enter relevant scores, friend preferences, and approved separation rules in Shibutz. The DOCX and its free-text notes are not automatically imported or interpreted as rules.
How to use it
- Download the template and make a school copy.
- Use the fictional example as a reference, then fill in the blank fields with only the details your team needs.
- Keep student notes objective and limited to placement needs.
- Use Shibutz for the class lists, constraints, and final results.
Related resources
Follow the class placement guide
Read the related guide or open the tool.
Set student preferences
Read the related guide or open the tool.
Add separation rules
Read the related guide or open the tool.
Balance class lists
Read the related guide or open the tool.
Class assignment report template
An editable staff report for recording final class assignments, balance checks, and review decisions.
Ready to build the class lists?
Use these files to collect staff input and record sign-off. In Shibutz, generate draft class lists and review their statistics. Pro adds Excel export for staff handoff.
Common questions
Should every teacher complete the form?
Use it where teacher judgment adds real information. For some grades, a short roster review may be enough.
Can the form be used for sensitive student notes?
Include only current information needed for the placement decision, and follow your school’s access and retention rules. Keep full histories and sensitive records in the approved system rather than copying them into this form.