Kennedy & Itkonen

SOCIAL CONTACT ASSESSMENT FORM

Completed by: Mindy Merten
EDSP 5389

Student:___Melissa Smith_____________
Dates: _____10/15_______to____10/17__________

Scale of 1-4 that meaningful contact was made.

Absence(s): _________0___________

1=poor contact; 2=neutral contact; 3=positive contact; 4=good contact; *=contact was made

Other:_________________

8:50 AM *2

*2

9:00 AM *3

*1
*1

Settings

*
*

9:15 AM *2

*1

9:45 AM *3

*4

10:00 AM
10:20 AM

*2
*2

room
r Play
Indoo

m
c Roo
Musi

round
Playg

Gym

Musi

Class
ro

om

/Indo
Rece
ss

P.E.

Eatin
g

Read
in

g Gro

other

up

or Pla

rs
Gran
dm

sable
Nondi

ates

d pee

ls
*2

Class
m

siona
rofes
Parap

her
Teac

Time
8:30 AM

Activities

People

10:30 AM

*3

10:45 AM *2

*2

*2

11:00 AM

*3

*1

11:30 AM

*2

12:00 PM

*2

*1

12:30 PM *3

*2

*3

1:00 PM *2

*2

*2

2:00 PM

*3

*2

*4

*
*

*
*

room