STUDENT NAME ID#



Student Name: FORMTEXT ?????Student ID: FORMTEXT ?????COMMENTS1ST Grading PeriodChronological Age: FORMTEXT ?????Your Child is demonstrating skills in the following ranges:Adaptive FORMTEXT ????? to FORMTEXT ?????Social-Emotional FORMTEXT ????? to FORMTEXT ?????Communication FORMTEXT ????? to FORMTEXT ?????Motor FORMTEXT ????? to FORMTEXT ?????Cognitive FORMTEXT ????? to FORMTEXT ?????Additional Comments:2nd Grading PeriodChronological Age: FORMTEXT ?????Your Child is demonstrating skills in the following ranges:Adaptive FORMTEXT ????? to FORMTEXT ?????Social-Emotional FORMTEXT ????? to FORMTEXT ?????Communication FORMTEXT ????? to FORMTEXT ?????Motor FORMTEXT ????? to FORMTEXT ?????Cognitive FORMTEXT ????? to FORMTEXT ?????Additional Comments:3rd Grading PeriodChronological Age: FORMTEXT ?????Your Child is demonstrating skills in the following ranges:Adaptive FORMTEXT ????? to FORMTEXT ?????Social-Emotional FORMTEXT ????? to FORMTEXT ?????Communication FORMTEXT ????? to FORMTEXT ?????Motor FORMTEXT ????? to FORMTEXT ?????Cognitive FORMTEXT ????? to FORMTEXT ?????Additional Comments:CODESN = Not Observed (skill has not been observed in classroom)E = Emerging (skill has been observed once or twice)D = Developing (skill has been observed three or four times)M = Mastered (skill has been observed five or more times)X = Not addressed (skill has not been addressed at this time)Student Name: FORMTEXT ?????DOB: FORMTEXT ?????Student ID: FORMTEXT ?????0-3 Months3-6 Months6-9 MonthsAdaptive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Swallows liquids easily FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Coordinates sucking, swallowing, and breathing FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Brings hands to mouth FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Opens mouth in anticipation of feeding FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Expresses pleasure when touching warm water FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Swallows pureed / strained food FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Use purposeful tongue movements FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Pulls food off spoon with lips FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Munches food (chewing up and down) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Places hands on a Sippy cup/adapted cup when drinking FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Eats pieces of solid food FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds and drinks from a Sippy cup FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cleans lower lip with teeth FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Chews in rotary/side to side movement FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Starts showing preference for certain foods FORMCHECKBOX All Skills MasteredSocial-Emotional FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Enjoys physical contact FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Smiles/responds to attention FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Comforted by familiar adult FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Attracts attention with sounds, smiling or using body language FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Draws attention to self, when in distress FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds differently to family members than strangers FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shows a desire to be picked up or held by familiar people FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Vocalizes pleasure and displeasure FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Turn toward or away from person or situation FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Laughs out loud during social play FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shows preferences for toys, activities, or places FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Expresses affection to a caregiver FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Repeats enjoyable activities FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Entertains self with toy for a short period of time FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Expresses protest & resists adult when toy is taken away FORMCHECKBOX All Skills MasteredCommunication FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cries to express a need FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Make single vowels sounds FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Looks at face of a person talking FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds to non-speech sounds outside of the field of vision FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Reacts to tones of voice and/or some facial expressions FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Babbles or Coos when spoken to FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Vocalizes instead of crying when alone FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Looks and vocalizes to own name FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Is soothed by a familiar adult voice FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Smiles and vocalizes to mirror image FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Combines syllables (consonant and vowels) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds to no FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses eye gage as a means of communication FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds to name FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Indicates no more or I don’t like this by vocalization turning or pushing away FORMCHECKBOX All Skills MasteredMotor FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Joins hands at midline FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN In prone position, lifts and turns head in both directions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds head steady when held FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds hands in a loose-fisted position, without holding an object FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds small object in hand FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Sits with light support FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shakes and plays with a noise making toy FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Reaches out and grasps objects FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Bangs two objects together FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Transfer an object from one hand to another FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Moves legs in a “stepping motion” when held FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Pokes with index finger FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Sits independently FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Crawls on belly (combat crawling) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Rakes objects with fingers against palm FORMCHECKBOX All Skills MasteredCognitive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Visually tracks light, objects, or other visual stimulus FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds to sounds FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Establishes and maintains eye contact FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Reaches for an object FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Reacts to disappearance of an object FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Explores environment, using visual or tactile exploration FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Demonstrates anticipatory excitement FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Engages in voluntary action FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Plays with toy for 30 seconds FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Performs 3+ different actions with various objects. FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds to mirror image FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Repeats an action to make something happen again FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Plays with a toy for 1 minute FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Overcomes obstacles to obtains toys FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Imitates a familiar action FORMCHECKBOX All Skills MasteredCODES: N=Not Observed, E=Emerging, D=Developing, M=Mastered, X=Not AddressedTeacher: FORMTEXT ?????Date: FORMTEXT ?????Teacher: FORMTEXT ?????Date: FORMTEXT ?????Teacher: FORMTEXT ?????Date: FORMTEXT ?????Student Name: FORMTEXT ?????Student ID: FORMTEXT ?????9-12 Months12-18 Months18-24 Months24-30 MonthsAdaptive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds, bites, and chews finger foods FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds a spoon while being fed FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Feeds self with fingers FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cooperates with dressing by extending arm or leg FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Pulls off socks FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Drinks from a cup with minimal assistance FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Scoops food from a dish with spoon FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cooperates in washing and drying hands FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Indicates discomfort over soiled pants FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cooperates in dressing and/or undressing FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Feeds self with minimal spilling FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Drinks from a straw FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Distinguishes between edible and nonedible substances FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Sits on potty chair /adapted chair with assistance FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Removes simple clothing (e.g. jacket) without assistance FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Begins to use a spork FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Gets drink unassisted FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Removes shoes FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Helps with simple household tasks (e.g. throwing trash, cleaning the table) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Urinates when placed on the toilet FORMCHECKBOX All Skills MasteredSocial-Emotional FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Watches others play FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Gives a toy to share with caregiver FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Repeats activities that elicits a positive response from others FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses objects to comfort self FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shows pleasure in Peek-A-Boo or other simple games FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Expresses more than one emotion FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Plays familiar social games FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Parallel plays FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Enjoys imitating adult activities FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Displays independent behavior (“NO” stage) FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Attends to small group activity FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Participates in “chase” games FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Engages in use of same materials with peers FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Sings familiar songs FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Asks for help FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Actively participates in large group songs / rhymes/ motions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Expresses “mine” FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Takes turns when prompted FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Purposefully joins another child’s play scheme/activity FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Recognizes emotions FORMCHECKBOX All Skills MasteredCommunication FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Makes requests using 1 or more modalities FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Follows simple commands with gestures FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Associates spoken words to familiar objects or actions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Exchanges sounds or gestures with another person FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Produces string of syllable combinations (jargon) FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Waves or responds to Hi and Bye FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Says two words besides mama and dada via vocalizations or SGD FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Imitates speech sounds FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Follows simple commands FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Points to picture in a book FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Can identify 6+ major body parts FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Combines at least 2 words to express idea FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses 10-20 words FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Makes choices for desired items FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identifies at least 15 familiar pictures FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Refers to themself by name FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Completes 2 step related directions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Produces some regular plurals (“cars”, “cups”) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Answers what and where questions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Comprehends at least ten action words FORMCHECKBOX All Skills MasteredMotor FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Pulls to stand FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Takes steps with assistance FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Puts objects in a container FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds a writing tool with fisted hand grasp FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses pincer grasp FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Walks without support FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Runs without direction with some falling FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds a large ball while walking FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Builds a tower using two blocks FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Places a round piece in a form board FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Walks up and down stairs hand held FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Kicks a large ball forward from standing position FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Imitates vertical and horizontal strokes FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Jumps in place FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Turns pages one at a time FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Catches a beanbag with arms against body while sitting FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Jumps in place with both feet together FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Rolls, pounds and squeezes play-doh or clay FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Imitates circular and cross strokes FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Places rings in a post FORMCHECKBOX All Skills MasteredCognitive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Releases an object into a container FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Looks, pats, points to, or turns pages in book FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Plays with a toy independently FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Imitates new motion FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Points or makes a new sound, expression, or gesture that another person makes FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Fills and dumps objects from a container FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Places round shape into foam board FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Finds hidden toy or reaches for an object from behind a barrier FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Attends to an activity for 15-30 seconds FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Hands a toy to an adult upon request FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Names at least 5 common objects FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identify animal sound w/ corresponding animal FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Stack up to 7 blocks FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Match familiar items to corresponding pictures FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Verbalizes dislikes instead of hitting or crying FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Searches for removed toy FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Matches simple shapes FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Finger play, ex Twinkle Twinkle, Wheels on Bus FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Points to pictures in a book FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Scribbles on paper FORMCHECKBOX All Skills MasteredStudent Name: FORMTEXT ?????Student ID: FORMTEXT ?????30-36 Months36-42 Months42-48 Months48-54 MonthsAdaptive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Pours liquid between containers FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Puts on all clothing without help (except for fasteners) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Indicates the need to use the toilet with some accidents FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Understands that hot is dangerous FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cleans up toys when asked FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Begins to use fork and napkin FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds accurately when asked if he/she needs to use the toilet FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Distinguishes between urination and bowel movements FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Knows the proper place for own things FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shows interest in setting the table FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Careful and caring with an animal or baby FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN States the need to use the toilet FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Controls bowel movements regularly FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Tells or describes an illness to an adult FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Acts with caution and avoids common dangers FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Asks for food at the table FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Obtains drink from a tap or other source FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Follows simple instructions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Initiates a requested task with reminders FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Washes and dries hands FORMCHECKBOX All Skills MasteredSocial-Emotional FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Transitions between activities when requested FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Imitates play activity of other children FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Engages in small group activity FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Get’s someone’s attention FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Initiates social interaction by offering an object or delivering message FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Remains with the group for teacher chosen activity FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shares toys by asking for or giving item FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Participates in classroom jobs FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Self-regulates after active play FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Participates in circle activities FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cleans up class materials FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shares materials with others FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Expresses frustration with words rather than physical action FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shows empathy FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Asks for assistance from an adult FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Talks about own feelings FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Shows pride in accomplishments FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Swaps materials with another child in play FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Initiates a play idea with a peer FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Recognizes another’s need for assistance and offers help (with prompt/model) FORMCHECKBOX All Skills MasteredCommunication FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Describes actions being performing FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Asks what and where questions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Understands some prepositions (i.e. in, on, under) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses 3 word phrases meaningfully FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identifies familiar objects by use FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Begins to understand simple time concepts (“Today”, “Tomorrow”) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Understands simple possessives (“baby’s”) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Can name at least five primary colors FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Produces sentences of at least 4 to 5 words FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Relates a short story about a current or recent activity FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Defines 5+ commonly used words FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Describes how objects are used FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Comprehends passive sentences (The girl was chased by the fox.) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Communicates for various reasons: i.e. request and identify FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Names creations and labels its elements FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Produces fluent 5-6 word sentences FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Describes what is similar about 2 different objects FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Completes analogies FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Indicates rhyming words FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Completes 2 step, unrelated verbal commands FORMCHECKBOX All Skills MasteredMotor FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Walks backwards FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Throws a ball with direction FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Pedals a tricycle FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Strings 4 large beads FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Builds a block tower with 8-10 blocks FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Catches a beanbag with arms while standing FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Runs without falling FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Snips paper with scissors FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses pads of fingertips to grasp pencil FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Begins to trace simple shapes FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Hits a large rolling ball with a bat FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Walks forward on a line on the floor FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Fastens clothing without assistance FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Draws a person with 2 parts FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Copies a cross FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Walks down stairs without assistance, alternating feet FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Balances on one foot FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Holds paper with one hand while drawing or writing with the other FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Copies any 2 letters FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cuts with scissors following a line FORMCHECKBOX All Skill MasteredCognitive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Matches by color, shape and size FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Rote counts to 10 FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Completes a simple inset puzzle FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Attempts to draw a person FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Demonstrates 1:1 correspondence FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identifies familiar objects by their use FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Chooses objects that are the same from an array of 3 FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Chooses different object from array of 3 FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Accurately responds to yes / no FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Answers simple what, where, who questions after a short story FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Retells an event from a picture book FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Completes a 6-8 piece puzzle FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Counts groups of objects up to 5 & can state the amount FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds signifying cause/effect (“This happened because…”) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Follows novel 2 step commands FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Sequences personal events (“First, Next, Last”) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Places 5-6 objects in order by size FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Names 4-6 shapes FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identifies the first letter of own name FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Demonstrates word awareness ( 1to 1 correspondence) FORMCHECKBOX All Skills MasteredStudent Name: FORMTEXT ?????Student ID: FORMTEXT ?????54-60 Months60-72 Months Adaptive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds to instructions given in a small group FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Washes and dries hands independently FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Wipes his nose independently when reminded FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses the toilet independently FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Initiates and organizes his/her personal belongings FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Behaves appropriately in public settings FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Takes care of all toileting needs (e.g. flushes, wipes, etc.) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Chooses appropriate clothing for an occasion or temperature FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses table knife for spreading FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Prepares simple foods FORMCHECKBOX All Skills Mastered Social-Emotional FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Plays games with rules FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Responds and initiates appropriate social interactions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Offers assistance to others FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Waits his or her turn for teacher’s or adults direction FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Follows classroom rules and expectations FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN States his or her first and last name FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Follows adult’s directions with little or no resistance FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cooperates in groups activities FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Discriminates between acceptable and unacceptable behavior FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Remains calm when requests are denied FORMCHECKBOX All Skills MasteredCommunication FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Uses words that describe the characteristics of objects FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Is able to join sentences together using conjunctions FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Understands and uses humor (tells jokes, makes funny statements) FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Understands and uses various regular plural forms FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Comprehends superlatives (biggest, longest) FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Makes inferences using context clues FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Constructs sentences with irregular plural forms FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Is able to comprehend complex sentences FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Recalls events sequentially from a passage of story read aloud FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Tells a short story containing varying details FORMCHECKBOX All Skills MasteredMotor FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Runs to and kicks a large moving ball FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Catches a small ball FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Colors within lines FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Folds a sheet of paper FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Draws a person with 7 unmistakable parts FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Skips on alternating feet FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Dribbles a ball FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Copies a simple word FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Copies numerals 1 through 5 FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Cuts out simple shapes FORMCHECKBOX All Skills MasteredCognitive FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Names 24-26 letters FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identifies a few letters that represent initial sound FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Continues simple AB pattern FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Counts objects up to 10 & can state the amount FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Retells story using pictures including items/actions FORMCHECKBOX All Skills Mastered FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Identifies or creates rhymes FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Writes first & last name from memory FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Matches 6-8 words with corresponding pictures FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Counts 2 sets of items and tells which has more FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN Answers simple why questions FORMCHECKBOX All Skills Mastered ................
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