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S.I.F.T.E.R.
SCREENING INSTRUMENT FOR TARGETING EDUCATIONAL RISK

by Karen L. Anderson, Ed.S., CCC-A
STUDENT ____________________________________ TEACHER ____________________ GRADE __________
DATE COMPLETED _____________ SCHOOL ________________________________ DISTRICT ____________
The above child is suspect for hearing problems which may or may not be affecting his/her school performance.
This rating scale has been designed to sift out students who are educationally at risk possibly as a result of hearing problems.
Based on your knowledge from observations of this student, circle the number best representing his/her behavior.
After answering the questions, please record any comments about the student in the space provided on the reverse side.
1. What is your estimate of the student's class standing in UPPER MIDDLE LOWER
comparison of that of his/her classmates? 5 4 3 2 1
ACADEMICS
2. How does the student's achievement compare to your estimation EQUAL LOWER MUCH LOWER
of her/her potential? 5 4 3 2 1
3. What is the student's reading level, reading ability group or UPPER MIDDLE LOWER
reading readiness group in the classroom (e.g., a student with 5 4 3 2 1
average reading ability performs in the middle group)?
4. How distractible is the student in comparison to his/her NOT VERY AVERAGE VERY
classmates? 5 4 3 2 1
ATTENTION
5. What is the student's attention span in comparison to that of his/ LONGER AVERAGE SHORTER
her classmates? 5 4 3 2 1
6. How often does the student hesitate or become confused when NEVER OCCASIONALLY FREQUENTLY
responding to oral directions (e.g., "Turn to page . . .")? 5 4 3 2 1
COMMUNICATION
7. How does the student's comprehension compare to the average ABOVE AVERAGE BELOW
understanding ability of her/her classmates? 5 4 3 2 1
8. How does the student's vocabulary and word usage skills ABOVE AVERAGE BELOW
compare with those of other student s in his/her age group? 5 4 3 2 1
9. How proficient is the student at telling a story or relating ABOVE AVERAGE BELOW
happenings from home when compared to classmates? 5 4 3 2 1
10. How often does the student volunteer information to class

PARTICIPATION
FREQUENTLY OCCASIONALLY NEVER
discussions or in answer to teacher questions? 5 4 3 2 1
CLASS
11. With what frequency does the student complete his/her class ALWAYS USUALLY SELDOM
and homework assignments within the time allocated? 5 4 3 2 1
12. After instruction, does the student have difficulty starting to NEVER OCCASIONALLY FREQUENTLY
work (looks at other students working or asks for help)? 5 4 3 2 1
13. Does the student demonstrate any behaviors that seem NEVER OCCASIONALLY FREQUENTLY
unusual or inappropriate when compared to other students? 5 4 3 2 1
BEHAVIOR
SCHOOL
14. Does the student become frustrated easily, sometimes to the NEVER OCCASIONALLY FREQUENTLY
point of losing emotional control? 5 4 3 2 1
15. In general, how would you rank the student's relationship GOOD AVERAGE POOR
with peers (ability to get along with others)? 5 4 3 2 1
Copyright ©1989 by Karen Anderson Author permission is granted for reproduction.

TEACHER COMMENTS
Has this child repeated a grade, had frequent absences or experienced health problems
(including ear infections and colds)? Has the student received, or is he/she now receiving,
special services? Does the child have any other health problems that may be pertinent to his/
her educational functioning?
The S.I.F.T.E.R. is a SCREENING TOOL ONLY

Any student failing this screening in a content area as determined on the scoring grid below should be
considered for further assessment, depending on his/her individual needs as per school district criteria. For
example, failing in the Academics area suggests an educational assessment, in the Communication area a
speech-language assessment, and in the School Behavior area an assessment by a psychologist or a social
worker. Failing in the Attention and/or Class Participation area in combination with other areas may suggest
an evaluation by an educational audiologist. Children placed in the marginal area are at risk for failing and
should be monitored or considered for assessment depending upon additional information.
SCORING
Sum the responses to the three questions in each content area and record in the appropriate box on the reverse
side and under Total Score below. Place an X on the number that corresponds most closely with the content
area score (e.g., if a teacher circled 3, 4 and 2 for the questions in the Academics area, an X would be placed
on the number 9 across from the Academics content area). Connect the X's to make a profile.
CONTENT AREA TOTAL PASS MARGINAL FAIL

SCORE
ACADEMICS 15 14 13 12 11 10 9 8 7 6 5 4 3
ATTENTION 15 14 13 12 11 10 9 8 7 6 5 4 3
COMMUNICATION 15 14 13 12 11 10 9 8 7 6 5 4 3
CLASS
PARTICIPATION 15 14 13 12 11 10 9 8 7 6 5 4 3
SOCIAL BEHAVIOR 15 14 13 12 11 10 9 8 7 6 5 4 3

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S.I.F.T.E.R.

SCREENING INSTRUMENT FOR TARGETING EDUCATIONAL RISK

STUDENT __________________________ TEACHER GRADE

DATE COMPLETED _ SCHOOL ________ DISTRICT

10. How often does the student volunteer information to class

Copyright ©1989 by Karen Anderson Author permission is granted for reproduction.

The S.I.F.T.E.R. is a SCREENING TOOL ONLY

CONTENT AREA TOTAL PASS MARGINAL FAIL

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