3 |
Student Last Name |
Student First Name |
Student ID # |
Gender |
Federal Ethnicity Category |
SpEd |
ELL |
Low |
GRADE |
TEACHER |
Student Promotion Index (SPI) Score |
ADK AM PM | |
Y/N |
Eng/Sp |
L/R/B |
1 - Never; 2 - infreq; 3 - 3 a wk;
4 - daily |
Prints Name |
Recog 0-10 in random order |
Counts up to 10 objects |
Retell familiar story |
Able to concent. for 5 mins |
Recog & express feelings |
Waits for a turn |
Tells story w/ details in order |
Colors & cuts with ease |
Counts to 30 |
Recog ABC in random order |
Recog & draws shapes |
Holds a pencil correctly |
Engages in Conver. |
Adapts to larger group |
Rhymes words | |
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