Preschool Assessment Form

Student Name: _______________________________________

Date of Birth: ______________________ Age: _______________

Date of Assessment: __________________ Assessor: ______________________

I. General Observations

• Overall Disposition:

  • [ ] Happy / Content

  • [ ] Reserved / Shy

  • [ ] Energetic

  • [ ] Fidgety / Restless

• Attention Span:

  • [ ] Short

  • [ ] Moderate

  • [ ] Long

• Transitioning:

  • [ ] Transitions easily between activities

  • [ ] Resists transitions

  • [ ] Requires prompting to transition

II. Social & Emotional Development

• Interaction with Peers:

  • [ ] Shares and takes turns

  • [ ] Plays cooperatively with others

  • [ ] Prefers to play alone

  • [ ] Initiates social interaction

• Interaction with Adults:

  • [ ] Responds to adult requests

  • [ ] Seeks help when needed

  • [ ] Seeks comfort from adults

• Self-Regulation:

  • [ ] Manages frustration appropriately

  • [ ] Expresses feelings with words

  • [ ] Can wait their turn patiently

III. Language & Communication Skills

• Expressive Language:

  • [ ] Uses complete sentences (4-5+ words)

  • [ ] Has a vocabulary of many words

  • [ ] Speech is clear and understandable

• Receptive Language:

  • [ ] Follows one-step directions

  • [ ] Follows two-step directions

  • [ ] Responds to questions

  • [ ] Understands concepts (e.g., in/out, up/down, big/small)

IV. Gross Motor Skills

• Movement:

  • [ ] Walks in a straight line

  • [ ] Runs smoothly

  • [ ] Jumps with two feet

  • [ ] Hops on one foot

• Ball Skills:

  • [ ] Throws a ball

  • [ ] Catches a bounced ball

V. Fine Motor Skills

• Hand Skills:

  • [ ] Holds a crayon/pencil with a proper grasp

  • [ ] Snips with scissors

  • [ ] Cuts along a line

  • [ ] Strings large beads

  • [ ] Uses dominant hand consistently

• Manipulative Play:

  • [ ] Completes simple puzzles (4-8 pieces)

  • [ ] Builds with blocks

  • [ ] Manipulates playdough

VI. Cognitive & Pre-Academic Skills

• Colors & Shapes:

  • [ ] Identifies basic colors (e.g., red, blue, green, yellow)

  • [ ] Identifies basic shapes (e.g., circle, square, triangle)

• Counting:

  • [ ] Recites numbers to 10

  • [ ] Counts objects accurately to 5

• Literacy:

  • [ ] Recognizes some letters of the alphabet

  • [ ] Recognizes their own name

• Problem-Solving:

  • [ ] Asks "why" questions

  • [ ] Completes simple sorting tasks

VII. Self-Help & Adaptive Skills

• [ ] Independently puts on and takes off coat/jacket

• [ ] Manages most of their own bathroom needs

• [ ] Washes hands independently

• [ ] Eats independently using utensils

VIII. Additional Notes & Comments