What is the name of the teacher completing this survey? *
Your answer
How well does this child consistently demonstrate gross motor skills (the ability to control the body in relation to objects, balance, agility, and general coordination)? *
Do you have any comments to share about this child's gross motor skills?
Your answer
How well does this child consistently demonstrate fine motor skills (eye-hand coordination; the ability to control small muscles of the hand for manipulation of pencil, scissors, small objects, early writing, and drawing)? *
Do you have any comments to share about this child's fine motor skills?
Your answer
How well does this child consistently demonstrate speech (articulation: control of oral musculature - teeth, tongue, and lips to produce sounds that are audible and understandable by others)? *
Do you have any comments to share about this child's speech (articulation)?
Your answer
How well does this child consistently demonstrate language (oral communication: use of phrases and sentences with proper grammar and parts of speech; evidence of clear thought patterns; willingness and ability to speak in front of others, including children and teacher)? *
Do you have any comments to share about this child's language (oral communication)?
Your answer
How well does this child consistently demonstrate pre-academic cognitive skills (knowledge of shapes, colors, numbers, and letters, as well as the ability to grasp new concepts and apply previously taught skills)? *
Do you have any comments to share about this child's pre-academic cognitive skills?
Your answer
How well does this child consistently demonstrate pre-academic behavior (willingness to attend to group discussion and instruction; ability to follow directions, work somewhat independently, and focus on the task; ability to control body for quiet listening)? *
Do you have any comments to share about this child's pre-academic behavior?
Your answer
How well does this child consistently demonstrate self-help skills (ability to toilet, feed, and dress with minimal assistance, tie shoes, zip jacket, use snaps and buttons)? *
Do you have any comments to share about this child's self-help skills?
Your answer
How well does this child consistently demonstrate socialization behavior (evidence of self-control; awareness of rules and consequences; playing cooperatively with peers; sharing and taking turns; responding appropriately to adult directions)? *
Do you have any comments to share about this child's socialization behavior?
Your answer
How well does this child consistently demonstrate creativity (ability to engage in imaginative play with other children and with toys, manipulatives, clay, etc.; curiosity and willingness to engage in new activities and with people and ideas)? *
Do you have any comments to share about this child's creativity?
Your answer
Please indicate this child's general temperament and/or predictable emotional responses (e.g., outgoing, generally quiet or shy, fearful of loud noises, needs frequent encouragement, etc.). *
Your answer
Please indicate any specific comments or concerns regarding this child. *
Your answer
Do you have additional information about this child that you would like to discuss with the school principal? *
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