Cognitive screening Incorrect responses will be noted below:
Number recognition (0-9):
Letter recognition:
Letter sounds:
Colors:
Shapes:
Teacher Evaluation: very good, good, Average, Needs Improvement
Attention Span
self-discipline
Social Maturity
class participation
Gross Motor skills
fine motor skills
Scoring will be interpreted in the following way:
107 – 126 Good success expected in Kindergarten
101 – 106 Above average success expected in Kindergarten
90 – 100 Average success expected in Kindergarten
81 – 89 Difficulty expected in Kindergarten
74 – 80 Great possibility of failure in Kindergarten
Section I -- "Draw A Man"
1.Draw a picture of a man. Make him look just like he would if he were standing right here. (Score four points for any of the following items present. 68 points possible).
Head, legs, arms, body, neck, eyes, nose, mouth, hair, feet clothing, hand, fingers, thumb, ear, eyebrows, other.
2.Print you name:
Section II – Score two points for every correct answer(32 points possible)
1. What has: a) wings b) four wheels
2. Tell me the color of a) grass b) an apple c) a banana
3. Which is larger: a) dog/cat b) cow/pig c) man/boy
4. What time of the year: a) do we swim b)does it snow
5. Which is faster: a) car/horse b) train/truck
6. How many wheels does: a) a motorcycle have b)a big wheel or tricycle have
7. When is: a) the 4th of July(summer) b)Christmas(winter)
Section III – Score two points for every correct answer (12 points possible).
1. What is ice when it melts? (water)
2. What makes a cloudy day bright? (sun)
3. If today is Sunday, what is tomorrow?
4. What makes the day warmer than night? (the sun)
5. How do we hear? (with our ears)
6. What are your eyes for? (to see or look)
Section IV – Score eight points for every correct answer (40 points possible)
1. Counting four squares (see above)
2. Fold a paper triangle (use attached sheet of square paper)
3. Repeat four digit numbers (one success in three trials)
4. Copy a square (one success in two trials)
5. Identify eight colors - red, orange, yellow, green, brown, blue, black, white (check incorrect answers)
Numbers and shapes
1 6 5 7 9 0 2 3 4 8
Star, circle, triangle, rectangle, oval, square, half circle.
Letters
The first box is checked if the child identified the letter correctly. The second box is checked if the child identified the sound of the letter or gave a word beginning with that letter. A check is make under the letters printed correctly by the child.
B b E e
D d H h
Z z F f
L l T t
M m U u
X x Y y
A a N n
C c P p
O o Q q
G g V v
I i S s
K k W w
J j R r