Academic Achievement, Functional Performance, and Learning Characteristics
A. Cognition
1. Does the child identify primary colors? {red, yellow, blue}
Yes
No
2. Does the child identify basic colors?
Yes
No
3. Does the child match colors?
Yes
No
4. Does the child identify shapes?
Yes
No
5. Which shapes does the child identify?
6. Does the child match shapes?
Yes
No
7. Does the child sort objects or pictures based on a single attribute (e.g., color, shape, size)?
Yes
No
8. Does the child categorize objects or pictures based on one characteristic?
Yes
No
9. What attributes does the child categorize by?
Color
Shape
Size
Type (e.g., animals, vehicles)
Function
Other:
B. Numeration
10. Does the child count by rote?
Yes
No
11. Which numbers does the child rote count?
12. Does the child recognize printed numbers?
Yes
No
13. Which numbers does the child recognize?
14. Does the child use one-to-one correspondence when counting objects?
Yes
No
15. Up to what number does the child use one-to-one correspondence?
16. Does the child match objects to their corresponding printed number?
Yes
No
17. Which number concepts does the child understand?
How many
More/Less
Equal to
All
None
Other:
C. Letters of the Alphabet
18. How many letters of the alphabet does the child identify?
19. Does the child associate letter sounds with their printed symbols?
Yes
No
20. Does the child recognize their own name in print?
Yes
No
D. Participation in the Instructional Process
21. Does the child remain seated during instruction and activities?
Yes
No
22. For approximately how long does the child remain seated?
23. Does the child maintain focus during instruction, a read-aloud, activities, and centers?
Yes
No
24. In which settings does the child best maintain attention?
Whole Group
Small Group
One-on-One
Varies
25. Does the child demonstrate understanding of classroom instruction, including comprehension of stories read aloud?
Yes
No
26. In which setting does the child best understand classroom instruction?
Whole Group
Small Group
One-on-One
Varies
27. Does the child respond to questions?
Yes
No
Other:
28. Does the child contribute to classroom discussions?
Yes
No
Other:
29. Does the child participate in choral singing of familiar songs?
Yes
No
Other:
30. Does the child attend to and complete tasks?
Yes
No
Other:
31. How often does the child complete tasks?
Always
Sometimes
Rarely
Never
Other:
32. Does the child follow classroom routines, rules, and schedules?
Yes
No
33. Does the child transition from a preferred to a non-preferred activity?
Yes
No
35. What strategies or supports are being implemented to improve the child's overall participation in the classroom and instructional process?
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