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Directions: For each item, place a check in the appropriate column
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Rarely |
Sometimes |
Always |
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Communication: |
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| 1. |
Follows three step unrelated directions. |
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| 2. |
Begins to use "can't", "do not" to mark negatives. |
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| 3. |
Average length of sentence is 5 words. |
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| 4. |
Can identify if words sound the same or different (light-right). |
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| 5. |
Makes up words having similar sounds |
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| 6. |
Asks definitions of words. |
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| 7. |
Uses prepositions--on, in under. |
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| 8. |
Listens to stories and answers questions or retells parts. |
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| 9. |
Asks "wh" questions--who, what, where, when, why. |
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| 10. |
Articulates clearly--speech is 95% intelligible. |
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Cognitive Skills: |
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| 1. |
Stacks set of graduated objects from smallest to largest. |
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| 2. |
Understands sequence of daily events (first we get up, get dressed, eat breakfast). |
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| 3. |
Understands concepts of size--big, bigger, biggest. |
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| 4. |
Recognizes own name printed. |
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| 5. |
Knows difference between printed letters and numbers. |
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| 6. |
Counts by rote to 20. |
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| 7. |
Counts out or gives 5 objects upon request. |
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| 8. |
Prints some letters of own name. |
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| 9. |
Knows full name, address, phone number. |
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| 10. |
Completes 8-10 piece puzzle independently. |
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Social / Emotional: |
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| 1. |
Establishes friendships (beginning to have a best friend). |
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| 2. |
Cooperates, participates in group activities. |
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| 3. |
Shows pride in accomplishment, seeks frequent adult approval. |
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| 4. |
Speaks spontaneously during all activities. |
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| 5. |
Answers questions, tends to brag, exaggerates and "bends" the truth. |
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| 6. |
Enjoys role playing and make believe. |
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| 7. |
Apologizes for mistakes. |
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| 8. |
Answers telephone and summons correct person. |
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| 9. |
Is independent but will seek help as needed from adults. |
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| 10. |
Follows schedules and classroom rules. |
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Self-Help Skills: |
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| 1. |
Sets the table for meals. |
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| 2. |
Can be depended upon to stay where told. |
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| 3. |
Is cautious about crossing the street. |
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| 4. |
Can go about the neighborhood / building unattended (to restroom, director's office). |
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| 5. |
Cleans up messy room. |
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| 6. |
Cleans up toys in class, putting them where they belong. |
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| 7. |
Pushes chairs under tables. |
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| 8. |
Independent in toileting needs; flushes, wash and dry hands. |
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| 9. |
Dries self without assistance after bathing. |
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| 10. |
Can dress and undress independently. |
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Fine and Gross Motor Skills: |
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| 1. |
Copies simple shapes and letters. |
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| 2. |
Cuts with scissors across a piece of paper. |
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| 3. |
Builds tower with 10 or more blocks. |
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| 4. |
Jumps forward and backward. |
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| 5. |
Skips or gallops fairly well. |
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| 6. |
Throws a ball forward at least 5 feet. |
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| 7. |
Kicks a ball forward. |
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| 8. |
Bounces a playground ball with one hand several times. |
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| 9. |
Walks on a line placing heel to toe for 6 feet. |
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| 10. |
Safely walks down stairs holding an object without holding a rail. |
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