Menlo Park City School District        Kindergarten Readiness Survey
The Kindergarten Readiness Survey is a part of Menlo Park City School District's placement process for children whose parents are requesting early or late kindergarten.   This survey is to be completed by the child's preschool/nursery school teacher prior to a recommendation being rendered for alternate placement. Parents may complete the form if their child does not attend preschool.  If you have any questions, please contact altplacement@mpcsd.org.

Directions:  Please answer each of the following questions to the best of your ability.  You can complete the survey on line or print a copy and mail it to:

Katherine Strach
Data/Assessment/EL Services Coordinator
MPCSD
181 Encinal Avenue
Atherton, CA 94027
Sign in to Google to save your progress. Learn more
Email *
What is the full name of the child for whom you are completing this survey? *
Who is completing this form? Please indicate your full name, position and name of preschool.   *
Expressive and Receptive Language
The child speaks in complete sentences...
Clear selection
The child understands and follows directions with at least two steps...
Clear selection
What is the child's primary language? *
Does the child speak a language other than English?  If yes, please indicate the language(s).  
The child understands vocabulary related to position, direction and size (like/different, top/bottom, first/last, big/little, up/down)...
Clear selection
Approach to Learning and Cognition
The child participates in a familiar songs, poems or rhymes...
Clear selection
The child can make simple predictions and comments about a story being read...
Clear selection
The child organizes objects that go together in a group...
Clear selection
The child identifies (5) colors.
Clear selection
The child is curious and initiates learning... *
Phonemic Awareness and Mathematics
The child recognizes his/her own name in print.
Clear selection
The child recognizes rhyming words.
Clear selection
The child can count 5 objects.
Clear selection
Social and Emotional
The child demonstrates independence in personal care (washing hands, dressing, bathroom use)...
Clear selection
The child separates from parents comfortably...
Clear selection
The child uses self control strategies to regulate feelings and behaviors in order to prevent himself/herself from acting impulsively...
Clear selection
The child shares materials and space with other students...
Clear selection
The child participates cooperatively in play with peers and understands the feelings of others...
Clear selection
The child is able to follow classroom routines...
Clear selection
Physical Development
The child can use writing/drawing tools to draw: a straight line, circle, 'X' and '+'.  
Clear selection
What placement would you recommend for this child? *
Other comments to support your placement recommendations...
This concludes the survey.  Thank you for your participation.  
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Menlo Park City School District. Report Abuse
Google Forms