Student Name *

First Name

Last Name

Date Completed

MM

DD

YYYY

Form completed by:

First Name

Last Name

1. Responds to appropriate boundaries with encouragement and support

Working Towards

Mastered

2. Plays alongside others

Working Towards

Mastered

3. Uses familiar adult as a secure base

Working Towards

Mastered

4. Starts to play co-operatively

Working Towards

Mastered

5. Explores new activities/environments

Working Towards

Mastered

6. Starts to engage in pretend/role play

Working Towards

Mastered

7. Desire to do things independently, uses 'no'

Working Towards

Mastered

8. Aware of, and responds to, others feelings

Working Towards

Mastered

1. Enjoys listening to rhythmic patters in stories and rhymes

Working Towards

Mastered

2. Tries to join in rhymes with actions or vocalizations

Working Towards

Mastered

3. Understands simple sentences, e.g., "throw the ball"

Working Towards

Mastered

4. Identifies objects by name when asked

Working Towards

Mastered

5. Copies familiar expressions

Working Towards

Mastered

6. Uses two words together

Working Towards

Mastered

7. Asks simple questions

Working Towards

Mastered

8. Talks about people / things not present

Working Towards

Mastered

1. Uses blocks to build a small tower

Working Towards

Mastered

2. Walks upstairs holding a banister or hand

Working Towards

Mastered

3. Tries new food textures and tastes

Working Towards

Mastered

4. Shows some sense of bladder/bowel control

Working Towards

Mastered

5. Can drink from a cup without spilling

Working Towards

Mastered

6. Awareness of what a toilet is for

Working Towards

Mastered

7. Desire to help with dressing/undressing and hygiene routines

Working Towards

Mastered