Name of Pupil: ________________________________Level of Readiness: _________
School: ______________________________________Grade & Section: ___________ Birthday: _____________________________________ Age: ____________________ Rater’s Name: ________________________________ Overall Score: _____________ Readiness Factors Quality of Response (to rate, put a check on the Very Good Fair Limited Very corresponding column) Good Limited (5) (4) (3) (2) (1) General Productiveness a. Originality of ideas b. Sentence structure c. Richness of word meanings d. Quality of speech Recognition of Relationships a. Appreciation for number b. Recall of details c. Associating new ideas d. Appreciation for space and size Mental and Physical Coordination (Give writing/coloring exercise related to the story) a. Muscular coordination b. Left-to-right progression c. Eye-hand coordination d. Organization and quality of thought units Auditory Discrimination (provide examples of sounds) a. Sound Difference 1. high and low 2. loud and soft 3. long and short (ex. Long a sound such as /cake/ and short a sound such as /cat/) 4. timbre (quality of sound) b. Rhyming words Visual Discrimination (provide examples of pictures related to the story) a. kind (category) b. size c. shape d. color Listening Comprehension a. Following directions b. Concentration (attention span) c. Understanding of story plot d. Understanding of characters e. Facility in retelling the story Comments (General Observations about the child) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________