Student Name *

First Name

Last Name

Date Completed

MM

DD

YYYY

Form completed by:

First Name

Last Name

1. Seeks out others to share experiences

Working Towards

Mastered

2. Shows affection/concern for people special to them

Working Towards

Mastered

3. May form a special friendship with another child

Working Towards

Mastered

4. Expresses own preferences and interests

Working Towards

Mastered

5. Seeks comfort when needed

Working Towards

Mastered

6. Can express their feelings

Working Towards

Mastered

7. Aware that some actions can hurt others

Working Towards

Mastered

8. Can stop themselves doing things they shouldn't

Working Towards

Mastered

9. Shows understanding and co-operates with some boundaries and routines

Working Towards

Mastered

1. Recognizes and responds to familiar sounds

Working Towards

Mastered

2. Listens with interest to stories

Working Towards

Mastered

3. Understands 2-part instructions

Working Towards

Mastered

4. Understands or asks "what, what, where" questions

Working Towards

Mastered

5. Uses language as a powerful means of sharing feelings, thoughts, experiences

Working Towards

Mastered

6. Learns new words rapidly

Working Towards

Mastered

7. Forms simple sentences

Working Towards

Mastered

1. Can kick a ball

Working Towards

Mastered

2. Turns pages of a book

Working Towards

Mastered

3. Climbs on climbing frame

Working Towards

Mastered

4. Squats and rises picking up objects

Working Towards

Mastered

5. Beginning to show preference for right or left hand

Working Towards

Mastered

6. Runs on whole foot

Working Towards

Mastered

7. Feeds self with spoon

Working Towards

Mastered

8. Clearly communicates need for the toilet

Working Towards

Mastered

9. Beginning to be independent in self care

Working Towards

Mastered