282 Mt. Paran Road, NW, Atlanta, GA 30327 p. 404-252-2591 f. 404-252-7615 www.schenck.org

Parent Assessment of Student’s Skills Kindergarten Application

Applicant Name:______________________________________________________________________________ First Middle Last

Please check the assessment of your child in each category. Please comment on any area that you would like us to know additional information about your child.

Yes No Yes No

PERSONAL COGNITIVE SKILLS

Can your child tell others his/her: Does your child:

First and last name? Identify letters in his/her name?

Age? Know the difference between a number and a letter?

Street address? Recognize numbers 1 through 10?

Birth date? Look at books independently?

Telephone number? Enjoy being read to?

VISUAL AND MOTOR SKILLS SOCIAL SKILLS

Does your child: Does your child:

Recognize his/her name in print? Usually share and take turns willingly?

Write his/her name? Usually play well with other children?

Enjoy drawing/coloring? Have experience participating in a small group?

Use scissors to cut paper? Show concern for using materials and equipment safely and appropriately?

Draw figures? EMOTIONAL/SELF RELIANCE

Describes the figure(s) that he/she has drawn?

Does your child:

Enjoy assembling puzzles? Willingly engage in a new activity?

Hop on one foot? Play independently?

Skip? Usually follow directions the first time they are given?

Throw and catch a ball? Usually stay with an activity until it is completed or until it is time to stop?

Use a dominant hand? Usually accept limits set by an adult?

SELF-HELP SKILLS Usually reflect a happy disposition?

Does your child: SPEECH AND LANGUAGE SKILLS

Button his/her clothing? Does your child:

Use the bathroom independently? Have speech that is understandable?

Have responsibility for (a) household chore(s)

Express needs and requests verbally?

Usually take care of personal needs? Tell stories that are easy to understand?

Benefit from a consistent schedule?

ADDITIONAL COMMENTS: