
Daily/Weekly Academic Report
Student Name: ____________________________________________________________________________________
APM0081 (2/12)
HCCM0023 (3/15)
Adapted from: 
Teenagers with ADD: A Parent’s Guide by Chris A. Zeigler Dendy, M.S. 1995.
Date:  /  /  Class Period:  Subject:
(+) = yes; (-) = no M T W T F
Homework 
turned in
On-task
Has needed 
materials
Unnished assignments?  
 ____ yes ____ no
Test grades C or better? 
 ____ yes ____ no
Comments:
Teacher Signature:
 ______________________________
Date:  /  /  Class Period:  Subject:
(+) = yes; (-) = no M T W T F
Homework 
turned in
On-task
Has needed 
materials
Unnished assignments?  
 ____ yes ____ no
Test grades C or better? 
 ____ yes ____ no
Comments:
Teacher Signature:
 ______________________________
Date:  /  /  Class Period:  Subject:
(+) = yes; (-) = no M T W T F
Homework 
turned in
On-task
Has needed 
materials
Unnished assignments?  
 ____ yes ____ no
Test grades C or better? 
 ____ yes ____ no
Comments:
Teacher Signature:
 ______________________________
Date:  /  /  Class Period:  Subject:
(+) = yes; (-) = no M T W T F
Homework 
turned in
On-task
Has needed 
materials
Unnished assignments?  
 ____ yes ____ no
Test grades C or better? 
 ____ yes ____ no
Comments:
Teacher Signature:
 ______________________________
Date:  /  /  Class Period:  Subject:
(+) = yes; (-) = no M T W T F
Homework 
turned in
On-task
Has needed 
materials
Unnished assignments?  
 ____ yes ____ no
Test grades C or better? 
 ____ yes ____ no
Comments:
Teacher Signature:
 ______________________________
Date:  /  /  Class Period:  Subject:
(+) = yes; (-) = no M T W T F
Homework 
turned in
On-task
Has needed 
materials
Unnished assignments?  
 ____ yes ____ no
Test grades C or better? 
 ____ yes ____ no
Comments:
Teacher Signature:
 ______________________________