School Function Assessment Summary Score Form
School Function Assessment Summary Score Form
Name:_________________________________ Date:___________
Functional Profile
-----------------------
Total Criterion
Raw Criterion Standard Cut-Off Score
Score Score Error K-3 4-6
0 10 20 30 40 50 60 70 80 90
0 10 20 30 40 50 60 70 80 90
Setting Reg/Spec Plygnd/Recess Transportation Bthrm/Toilet Transitions Meal/Snack
Rating
Optional Tasks
Physical Tasks
Cognitive/Behavioral Tasks
Part I Participation
Regular Classroom + 5 Settings 100 100
Special Education Classroom + 5 Settings
Part II Task Supports
Physical Tasks-Assistance 100 100
Physical Tasks-Adaptations 100 100
Cognitive/Behavioral Tasks-Assistance 77 92
Cognitive/Behavioral Tasks-Adaptations 91 100
Up/Down Stairs-Assistance
Up/Down Stairs-Adaptations
Written Work-Assistance
Written Work-Adaptations
Computer and Equipment Use-Assistance
Computer and Equipment Use-Adaptations
Part III Activity Performance
Travel 100 100
Maintaining and Changing Position 100 100
Recreational Movement 83 100
Manipulation With Movement 93 100
Using Materials 83 100
Setup and Cleanup 87 100
Eating and Drinking 100 100
Hygiene 92 100
Clothing Management 93 100
Up/Down Stairs 100 100
Written Work 73 94
Computer and Equipment Use 65 100
Functional Communication 91 100
Memory and Understanding 79 100
Following Social Conventions 73 92
Compliance With Adult Directives and School Rules 76 82
Task Behavior /Completion 72 81
Positive Interaction 81 83
Behavior Regulation 74 78
Personal Care Awareness 92 100
Safety 91 100
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