Please enable JavaScript in your browser to complete this form.Child's Name *Date of BirthTeacher’s Name: *Assessment DateEnglish/ Language ArtsDemonstrate continual growth in understanding increasingly complex and varied vocabularyYes/NoYesNoCommentsRespond to simple sentences, phrases, gestures, and/or actionsYes/NoYesNoCommentsFollow simple one-step directionsYes/NoYesNoCommentsDemonstrate continual growth in increasingly varied and complex vocabularyYes/NoYesNoCommentsUse gestures and actions to communicateYes/NoYesNoCommentsUse simple phrases or simple sentencesYes/NoYesNoCommentsTalk about past, present, and future eventsYes/NoYesNoCommentsTake turns in a conversationYes/NoYesNoCommentsRespond to a request for clarificationYes/NoYesNoCommentsRecognize and identify some frequently occurring letters in contextYes/NoYesNoCommentsRecognize symbols have meaningYes/NoYesNoCommentsBegin to engage in word and sound play with adultsYes/NoYesNoCommentsDistinguish between words that contain similar - sounding phonemes (pig-jig, cat-mat)Yes/NoYesNoCommentsRecognize familiar books by coverYes/NoYesNoCommentsRecite parts of well-known stories, rhymes, and songsYes/NoYesNoCommentsHold books with two hands and turns pagesYes/NoYesNoCommentsShow preference for familiar stories and report phrases of the storyYes/NoYesNoCommentsAnswer simple questions about a storyYes/NoYesNoCommentsTell a story from pictures in the bookYes/NoYesNoCommentsMake scribbles or shapes to convey meaningYes/NoYesNoCommentsImitate simple lines and shapesYes/NoYesNoCommentsExperiment with a variety of writing tools, materials, and surfacesYes/NoYesNoCommentsDraw pictures and scribble to generate and express ideasYes/NoYesNoCommentsDictate a story for an adult to writeYes/NoYesNoCommentsMathCount the number sequence 1-5Yes/NoYesNoCommentsBegin to apply verbal counting sequence to objects in order to develop one-to-one correspondenceYes/NoYesNoCommentsBegin to recognize that number symbols indicate quantityYes/NoYesNoCommentsBegin to recognize different number symbols indicate different quantitiesYes/NoYesNoCommentsVisually identify sets of quantities of large differences (using terms more and/or fewer)Yes/NoYesNoCommentsBegin to identify first and lastYes/NoYesNoCommentsGive some when askedYes/NoYesNoCommentsGive the rest when askedYes/NoYesNoCommentsCommunicate that something is split in halfYes/NoYesNoCommentsUnderstand the basic concept of noneYes/NoYesNoCommentsDescribe that something was taken awayYes/NoYesNoCommentsIdentify that an object has been added to a groupYes/NoYesNoCommentsBegin to make reasonable estimates related to quantityYes/NoYesNoCommentsRecognize natural patterns in the environmentYes/NoYesNoCommentsVerbally or non-verbally predict what comes next when shown a simple ABAB pattern of concrete objectsYes/NoYesNoCommentsShow greater recognition of daily routinesYes/NoYesNoCommentsIdentify similarities and differences in objectsYes/NoYesNoCommentsComplete basic shape interlocking puzzle with most pieces accurately in place with some assistanceYes/NoYesNoCommentsMatch similar shapes that are different sizes, and different orientation with a variety of two-dimensional shapesYes/NoYesNoCommentsFollow steps in a simple routineYes/NoYesNoCommentsSort objects into two categories based on attributesYes/NoYesNoCommentsExplore measurement using non-standard toolsYes/NoYesNoCommentsSocial Emotional SkillsUses gestures and actions to reference self in conversationYes/NoYesNoCommentsDemonstrate use of personal pronounsYes/NoYesNoCommentsShow sense of self satisfaction with own abilities and preferencesYes/NoYesNoCommentsBegin to show independence by occasionally resisting adult controlYes/NoYesNoCommentsExpress both positive and negative feelings about participant in activitiesYes/NoYesNoCommentsObserve a peer’s emotion and approach a familiar adult to communicate concernYes/NoYesNoCommentsDemonstrate empathy to another childYes/NoYesNoCommentsBegin to use words to express feelingsYes/NoYesNoCommentsFollow simple routines with adult supportYes/NoYesNoCommentsSelf-soothe independentlyYes/NoYesNoCommentsRegulate some impulses with adult supportYes/NoYesNoCommentsEngage in simple conflict resolution strategies with adult supportYes/NoYesNoCommentsBegin to use language skills instead of physical force to resolve conflictsYes/NoYesNoCommentsStay connected with familiar adultsYes/NoYesNoCommentsSeparate from familiar adults in a familiar setting with minimal distressYes/NoYesNoCommentsAsk for adult assistance when having difficulty in a social situationYes/NoYesNoCommentsImitate and model friendship skillsYes/NoYesNoCommentsEngage in parallel playYes/NoYesNoCommentsBegin to exhibit skills in associative playYes/NoYesNoCommentsApproaches to Play and LearningAt times, initiate a new taskYes/NoYesNoCommentsVerbally express a desire to complete task by selfYes/NoYesNoCommentsIndependently select and use materialsYes/NoYesNoCommentsAsk questions about novel objects, people, and experiencesYes/NoYesNoCommentsDemonstrate enthusiasm for new learning (may be with familiar context)Yes/NoYesNoCommentsUse active exploration to solve a problemYes/NoYesNoCommentsSubstitute one object for another in pretend play or pretend with objects that may or may not be presentYes/NoYesNoCommentsShow creativity, inventiveness, and flexibility in approach to play with adult guidanceYes/NoYesNoCommentsAttend to a book for longer periods of time (jointly or independently)Yes/NoYesNoCommentsFocus on an activity for short periods of time despite distractionsYes/NoYesNoCommentsRepeat an activity may times in order to master it even if setbacks occurYes/NoYesNoCommentsEngage in parallel playYes/NoYesNoCommentsBegin to exhibit skills in associative playYes/NoYesNoCommentsParticipate in play activities with a small group of children for short periods of timeYes/NoYesNoCommentsScienceUse simple words to describe sensory experiences, objects, and how objects moveYes/NoYesNoCommentsIdentify and solve problems in the environment through active explorationYes/NoYesNoCommentsDescribe physical properties using simple wordsYes/NoYesNoCommentsNotice own shadowYes/NoYesNoCommentsName objects in the skyYes/NoYesNoCommentsUse tools to explore various earth materialsYes/NoYesNoCommentsCommunicate awareness that the environment, weather, and seasons changeYes/NoYesNoCommentsseasons change Name different kinds of weatherYes/NoYesNoCommentsName characteristic of living organismsYes/NoYesNoCommentsName more complex body partsYes/NoYesNoCommentsUse tools to serve a purpose or solve a problemYes/NoYesNoCommentsNotice whether the solution was successfulYes/NoYesNoCommentsUse complex motions to play with simple machinesYes/NoYesNoCommentsDemonstrate curiosity and ask for more informationYes/NoYesNoCommentsUse tools to explore the environmentYes/NoYesNoCommentsSocial StudiesParticipate in and imitate celebrations and other cultural events for family, peers, and community if observedYes/NoYesNoCommentsBegin to demonstrate a sense of belonging to a group by engaging in associate playYes/NoYesNoCommentsBegin to gesture and ask simple questions regarding differences and/or similarities between self and othersYes/NoYesNoCommentsBegin to recognize the sequence of events as part of a daily routineYes/NoYesNoCommentsBegin to recall information from recent experiencesYes/NoYesNoCommentsBegin to recognize familiar aspects of community or cultural symbolsYes/NoYesNoCommentsBegin to demonstrate an understanding of rulesYes/NoYesNoCommentsBegin to use simple location termsYes/NoYesNoCommentsExperiment with materials to represent objects in playYes/NoYesNoCommentsDescribe the characteristics of home and surroundingsYes/NoYesNoCommentsKnow the location of objects and places in familiar environmentsYes/NoYesNoCommentsExplore characteristics and ask questions about aspect of the environmentYes/NoYesNoCommentsUse props related to buying and selling items during playYes/NoYesNoCommentsCommunicate wants and needsYes/NoYesNoCommentsRecognize various familiar workers in the communityYes/NoYesNoCommentsBegin to role play different jobsYes/NoYesNoCommentsParticipate in simple routines with adult supportYes/NoYesNoCommentsIdentify preferencesYes/No (copy)YesNoCommentsCreative ArtsRespond to music by moving own bodyYes/NoYesNoCommentsExperiment with vocalizations, sounds, and musical instrumentsYes/NoYesNoCommentsInitiate singing a song repeatedlyYes/NoYesNoCommentsProduce rhythmic patterns to familiar songsYes/NoYesNoCommentsUse dance for self-expressionYes/NoYesNoCommentsEnjoy repetition of materials and experiencesYes/NoYesNoCommentsUse a variety of mediaYes/NoYesNoCommentsCommunicate preferences while looking at pictures, photographs, and illustrationsYes/NoYesNoCommentsCompare and contrast own creations and those of othersYes/NoYesNoCommentsEngage in parallel playYes/NoYesNoCommentsBegin to exhibit skills in associative playYes/NoYesNoCommentsSpontaneously pretend to take on the characteristics of a person, character or animalYes/NoYesNoCommentsExpress self through dramatic playYes/NoYesNoCommentsPhysical Health and GrowthPractice health and hygiene-related behaviors with remindersYes/NoYesNoCommentsImitate an experience of participating in a doctor or dentist visitYes/NoYesNoCommentsDemonstrate awareness of dangerYes/NoYesNoCommentsRespond to adult guidance and direction regarding safetyYes/NoYesNoCommentsExpress when hungry or fullYes/NoYesNoCommentsMake simple food choices depending on personal and cultural preferenceYes/NoYesNoCommentsCommunicate about various characteristics of foodYes/NoYesNoCommentsFeed self with minimal assistanceYes/NoYesNoCommentsTest objects to determine their purposeYes/NoYesNoCommentsIdentify basic body partsYes/NoYesNoCommentsDemonstrate awareness of own body in space and in relationship to objectsYes/NoYesNoCommentsParticipate in active physical play and structured activities requiring spontaneous and instructed body movementsYes/NoYesNoCommentsUse hand-eye coordination to manipulate smaller objects with increasing controlYes/NoYesNoCommentsDevelop coordination and balanceYes/NoYesNoCommentsDevelop gross motor control for a range of physical activitiesYes/NoYesNoCommentsDemonstrate continual progression in oral muscle tone, strength, and range of motion, leading to more complex oral movement and controlYes/NoYesNoCommentsParticipate with adult support in personal body care practicesYes/NoYesNoCommentsParticipate with adult support in dressing and undressing selfYes/NoYesNoCommentsCommunicate toileting needsYes/NoYesNoCommentsThe purpose of this assessment is to inform planning for overall program improvements. This assessment should be done individually during center time or free play by the director, lead teacher or assistant teacher in this particular classroom. Yes/No Comments Comments: Individualized Activity PlanName *FirstLastAgeWeek ofArea(s) of Strengths:Area(s) of Improvement:Activities to help improve:Procedures:IN Standards and Foundations:Comments:Submit