Menlo Park City School District Kindergarten Readiness Survey
The Kindergarten Readiness Survey is a part of Menlo Park City School District's placement process for children whose parents are requesting early or late kindergarten. This survey is to be completed by the child's preschool/nursery school teacher prior to a recommendation being rendered for alternate placement. Parents may complete the form if their child does not attend preschool.

Directions: Please answer each of the following questions to the best of your ability. You can complete the survey on line or print a copy and mail it to:

Katherine Strach
Data/Assessment/EL Services Coordinator
MPCSD
181 Encinal Avenue
Atherton, CA 94027
Email address *
What is the full name of the child for whom you are completing this survey? *
Your answer
Who is completing this form? Please indicate your full name, position and school. *
Your answer
Expressive and Receptive Language
The child speaks in complete sentences... *
The child understands and follows directions with at least two steps... *
What is the child's primary language? *
Your answer
Does the child speak a language other than English? If yes, please indicate the language(s). *
Your answer
The child understands vocabulary related to position, direction and size (like/different, top/bottom, first/last, big/little, up/down)... *
Approach to Learning and Cognition
The child participates in a familiar songs, poems or rhymes... *
The child can make simple predictions and comments about a story being read... *
The child organizes objects that go together in a group... *
The child identifies (5) colors. *
The child is curious and initiates learning... *
Phonemic Awareness and Mathematics
The child recognizes his/her own name in print. *
The child recognizes rhyming words. *
The child can count 5 objects. *
Social and Emotional
The child demonstrates independence in personal care (washing hands, dressing, bathroom use)... *
The child separates from parents comfortably... *
The child uses self control strategies to regulate feelings and behaviors in order to prevent himself/herself from acting impulsively... *
The child shares materials and space with other students... *
The child participates cooperatively in play with peers and understands the feelings of others... *
The child is able to follow classroom routines... *
Physical Development
The child can use writing/drawing tools to draw: a straight line, circle, 'X' and '+'. *
What placement would you recommend for this child? *
Other comments to support your placement recommendations...
Your answer
This concludes the survey. Thank you for your participation.
A copy of your responses will be emailed to the address you provided.
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