Kindergarten Assessment Form

Student Name: __________________________________ Date of Assessment: __________________________ Assessor's Name: ____________________________

Academic Skills

Literacy

Recognizes all uppercase letters: (Circle one) Yes / No
Recognizes all lowercase letters: (Circle one) Yes / No
Identifies 10+ letter sounds: (Circle one) Yes / No
Recognizes own name in print: (Circle one) Yes / No
Attempts to write own name: (Circle one) Yes / No
Identifies rhyming words: (Circle one) Yes / No

Numeracy

Counts to 20: (Circle one) Yes / No
Recognizes numbers 1-10: (Circle one) Yes / No
Identifies basic shapes (circle, square, triangle): (Circle one) Yes / No
Sorts objects by color, size, or shape: (Circle one) Yes / No
Identifies simple patterns: (Circle one) Yes / No

Social-Emotional and Motor Skills

Social-Emotional

Follows 2-step directions: (Circle one) Yes / No
Shares and takes turns: (Circle one) Yes / No
Interacts positively with peers: (Circle one) Yes / No
Expresses needs and feelings appropriately: (Circle one) Yes / No
Separates from parent/caregiver with ease: (Circle one) Yes / No

Fine Motor

Holds pencil/crayon with a tripod grasp: (Circle one) Yes / No
Cuts with scissors along a straight line: (Circle one) Yes / No
Draws a simple human figure (head, body, arms, legs): (Circle one) Yes / No
Completes simple puzzles (4-6 pieces): (Circle one) Yes / No

Gross Motor

Jumps with both feet together: (Circle one) Yes / No
Hops on one foot: (Circle one) Yes / No
Runs without falling: (Circle one) Yes / No

Assessor Notes and Observation

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