Kindergarten Round Up
Student Information
Student First Name *
Your answer
Student Last Name *
Your answer
Parent Name *
Your answer
Phone Number *
Your answer
Interview Information
Evaluation Date *
MM
/
DD
/
YYYY
Teacher Evaluating Student *
Screening Questions
Knows name *
Able to write name *
Uses *
Fine motor skills *
Comments on writing skills
Your answer
Colors identified out of 8 *
Your answer
Can count up to *
Your answer
Letter recognition *
Enter number of letters correctly identified out of 20
Your answer
Letter Sounds Recognized *
Enter number of letters correctly identified out of 9
Your answer
Words Recognized *
Enter number of letters correctly identified out of 7
Your answer
Speech Abilities *
Answer based on students response to final oral question
Comments on speech abilities
Your answer
Overall Analysis
Numeracy Ability *
Literacy Ability *
Speech Ability *
Overall Ability *
Additional notes / comments
Your answer
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