Kindergarten Readiness Form Student's Full Name * First Name Last Name Email * Gender * Date of Birth * Age * Parent Information Name * First Name Last Name Email * Cell Phone * (###) ### #### Email * Academic information: counts a set of objects up to 10 Strongly Disagree Disagree Neutral Agree Strongly Agree identifies numerals 0-9 Strongly Disagree Disagree Neutral Agree Strongly Agree attends to an age-appropriate story Strongly Disagree Disagree Neutral Agree Strongly Agree recalls information over a period of time Strongly Disagree Disagree Neutral Agree Strongly Agree identifies similarities and differences Strongly Disagree Disagree Neutral Agree Strongly Agree writes his/her first name legibly Strongly Disagree Disagree Neutral Agree Strongly Agree prints letters with appropriate formations Strongly Disagree Disagree Neutral Agree Strongly Agree colors neatly without assistance Strongly Disagree Disagree Neutral Agree Strongly Agree identifies all letter names and sounds Strongly Disagree Disagree Neutral Agree Strongly Agree reads 50 sight words Strongly Disagree Disagree Neutral Agree Strongly Agree demonstrates comprehension of a story read aloud Strongly Disagree Disagree Neutral Agree Strongly Agree shares comments/thoughts about a story/topic Strongly Disagree Disagree Neutral Agree Strongly Agree looks at or reads a story independently Strongly Disagree Disagree Neutral Agree Strongly Agree comments pertaining to academic abilities: Social Emotional Information: follows simple 2-3 step directions Strongly Disagree Disagree Neutral Agree Strongly Agree participates in a teacher-led activity for 5 minutes without redirection Strongly Disagree Disagree Neutral Agree Strongly Agree participates in a teacher-led activity for 10 minutes without redirection Strongly Disagree Disagree Neutral Agree Strongly Agree looks to join a peer during free play Strongly Disagree Disagree Neutral Agree Strongly Agree expresses feelings to adults and peers Strongly Disagree Disagree Neutral Agree Strongly Agree participates in group discussions Strongly Disagree Disagree Neutral Agree Strongly Agree follows daily routines Strongly Disagree Disagree Neutral Agree Strongly Agree accepts redirection from adults Strongly Disagree Disagree Neutral Agree Strongly Agree demonstrates behavioral meltdowns when wants are not met Strongly Disagree Disagree Neutral Agree Strongly Agree comments pertaining to social emotional abilities: Personal information: Uses the restroom independently Strongly Disagree Disagree Neutral Agree Strongly Agree Washes hands with soap independently Strongly Disagree Disagree Neutral Agree Strongly Agree Puts on and takes off coat Strongly Disagree Disagree Neutral Agree Strongly Agree Buttons and zips up shirt and pants Strongly Disagree Disagree Neutral Agree Strongly Agree Works on tasks independently Strongly Disagree Disagree Neutral Agree Strongly Agree Separates easily from parents/guardians to begin school day Strongly Disagree Disagree Neutral Agree Strongly Agree comments pertaining to personal abilities: Physical information: cuts with scissors Strongly Disagree Disagree Neutral Agree Strongly Agree ties his/her own shoes Strongly Disagree Disagree Neutral Agree Strongly Agree walks up and down stairs independently Strongly Disagree Disagree Neutral Agree Strongly Agree participates in gross motor activities without assistance (catches a ball, jumps rope, skipping, climbing, etc.) Strongly Disagree Disagree Neutral Agree Strongly Agree holds pencil correctly (tripod grip) Strongly Disagree Disagree Neutral Agree Strongly Agree able to open lunch containers and water bottle independently Strongly Disagree Disagree Neutral Agree Strongly Agree able to pack and unpack backpack independently Strongly Disagree Disagree Neutral Agree Strongly Agree Comments pertaining to physical abilities: communication information Asks for help from an adult or teacher when in need Strongly Disagree Disagree Neutral Agree Strongly Agree expressive language is easily understood Strongly Disagree Disagree Neutral Agree Strongly Agree becomes frustrated when he/she is not understood Strongly Disagree Disagree Neutral Agree Strongly Agree uses expressive language to convey needs and wants Strongly Disagree Disagree Neutral Agree Strongly Agree responds to age appropriate questions Strongly Disagree Disagree Neutral Agree Strongly Agree speaks in complete sentences Strongly Disagree Disagree Neutral Agree Strongly Agree comments pertaining to communication abilities: Other Questions: What are the strengths of the child in an educational setting? * What are the primary needs and/or difficulties of the child? * Are there any needs or issues (academic, behavior, and/or communication) we should be aware of? * Has your child received any type of evaluations in the past or have one scheduled? * If yes, please email a copy of the evaluation and/or feedback to stephanie@crestwooddayschool.org I acknowledge that the information provided above is reported correctly to the best of my knowledge. I also give permission to Crestwood Day School staff to speak with my child's previous teachers and administrators. Signature of Parent or Guardian * Date * MM DD YYYY Thank you!
