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

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download