Hero Checklist (2 to 4 years)

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We want to know more about your Hero! The more we know about them, the better we may be able to serve them and your family.

Please answer one checklist per child. You can select more than one answer if needed on each question.

We appreciate your honesty. Please keep in mind, there are no right or wrong answers!

Please answer N/A on any questions that do not apply. Feel free to answer in either English or Spanish.

Email *

What is your full name? *

What is your cellphone number? *

What is your Hero's full name? *

How old is your Hero? (specify years and months) *

What is their birth date? *

YYYY

What has been your child's learning experience so far? *

Home

Bubble group with few children

Pre-school/child-care environment

Required

For how long? *

What is the name of the pre-school, child-care, bubble group? Mark N/A if it does not apply *

Language/Communication: What stage is your child at? *

Points to things in a book when you ask, like “Where is the bear?”

Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes

Says single words ("Mamá", "Ayuda", "Porfavor")

Says at least two words together, like “Más leche”

Talks with you in conversation using at least two back-and-forth exchanges

Says sentences with four or more words

Answers simple questions

Asks questions

Required

Social/Emotional: What stage is your child at? *

Plays side by side with other children, each focused in their own play

Joins other children to play together

Pretends to be something/someone else during play

Asks to play with children if none are around

Expresses strong feelings through body language only, laughing, jumping, crying, biting

Expresses strong emotions verbally using single words ("duele", "mordió", ‘’quitó")

Expresses emotions verbally and can tell what made them feel this way

Notices other children and their feelings

Comforts others who are hurt or sad

Changes behavior drastically in new situations/settings

Maintains usual behavior everywhere they go

Adapts their behavior based on the situation or surroundings

Feels uncomfortable with adults other than their parents

Feels comfortable around familiar adults other than their parents

Feels comfortable with unknown adults

Required

Cognitive Milestones (learning, thinking, problem-solving): What stage is your child at? *

Holds something in one hand while using the other hand; for example, holding a container and taking the lid off

Tries to use switches, knobs, or buttons on a toy

Plays with more than one toy at the same time, like putting toy food on a toy plate

Draws a circle, when you show them how

Avoids touching hot objects, like a stove, when you warn her

Names a few colors of items

Tells what comes next in a well-known story

Draws a person with three or more body parts

Required

Movement/Physical Development Milestones: What stage is your child at? *

Kicks a ball

Runs

Walks (not climbs) up a few stairs with or without help

Eats with a spoon

Strings items together, like large beads or macaroni

Puts on some clothes by himself, like loose pants or a jacket

Uses a fork

Catches a large ball most of the time

Serves himself food or pours water, with adult supervision

Unbuttons some buttons

Holds crayon or pencil between fingers and thumb (not a fist)

Required

Has your child had any observations by an expert/teacher/guide on any of these challenges? *

Motor (cannot hold pencil/crayon, cannot eat with fork/spoon, cannot dress/undress)

Learning (does not speak/read/write according to age, attention/concentration difficulties)

Behavioral (doesn't follow instructions, hits or bites others, hides when uncomfortable)

Emotional (rage outburts, difficulty calming down, separation anxiety, fears)

Other

None

Required

Please, tell us more: *

Has you child attended/is currently attending any kind of therapy, special classes or individual sessions with any kind of specialist? *

Yes

Please, tell us more: (Name of therapist/specialist, name of center/school, reason and time period). If answer is no, mark N/A.

Does your child has had any type of diagnostic? *

Yes

Please, tell us more. If so, what diagnostic? If answer is no, N/A. *

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