Student Inventory

Child's Name

Date of Birth

My Child Is

Left Handed

Right Handed

Unsure

My Child's Previous School / Daycare Experience

Please check the box that best describes how often you see that behavior in your child (in group situations or at home).

Can play cooperatively with other children

Never

Rarely

Sometimes

Often

Always

Can sit and listen to a story

Never

Rarely

Sometimes

Often

Always

Follows instructions from adults

Never

Rarely

Sometimes

Often

Always

Is constantly in motion

Never

Rarely

Sometimes

Often

Always

Can dress themselves

Never

Rarely

Sometimes

Often

Always

Make friends easily

Never

Rarely

Sometimes

Often

Always

Waits their turn

Never

Rarely

Sometimes

Often

Always

Adjusts well to new situations/environments

Never

Rarely

Sometimes

Often

Always

Is able to separate from parent without extreme distress

Never

Rarely

Sometimes

Often

Always

Asks for help when needed

Never

Rarely

Sometimes

Often

Always

Follows rules

Never

Rarely

Sometimes

Often

Always

Participates in clean-up

Never

Rarely

Sometimes

Often

Always

Responds to redirection

Never

Rarely

Sometimes

Often

Always

Understands questions/conversations

Never

Rarely

Sometimes

Often

Always

Takes turns with toys and activities

Never

Rarely

Sometimes

Often

Always

Is easily frustrated

Never

Rarely

Sometimes

Often

Always

Participates in discussions

Never

Rarely

Sometimes

Often

Always

Uses physical means instead of words

Never

Rarely

Sometimes

Often

Always

Shows self-control

Never

Rarely

Sometimes

Often

Always

Is easily distracted

Never

Rarely

Sometimes

Often

Always