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Test of Gi Mote a : TGMD-2 oven BEEN lion Profile/Examiner Record Form Eee Name School Referted by - — Reason for Refercal Male (Female Grade Date of Testing Date of Birth age Examiner Examiner's Title ESE First Testing Second Testing Raw Standard Age Score Score Percentile Equivalent Raw Standard Age Score Score Percentile Equivalent Locomotor Object Control Locomotor Object Control Sum of standars Scores ‘Gross Motor Quotient Sum of standard Scores ‘Gross Motor Quotient Te 1. Place Tested Inteering Wat interfering i bad 8. Noise Level v2 os as i bl go imruptions 12003 4 : © Distractions 12003 4 5 a = cust 1 32 a4 5 * a F. Temperature 1 2 BOA 5 i i G. Notes and ether considerations : "6 SE i : Name of Test Date Standard TGMO-2 : $ Score Equivalent ih 8 SY ROD. F mnt eat, oe, Th ube Partorhia Meloediind HONE ef net eebnaes aes eee ofies cleat er fs ae =e =e Sal nara =e shure Eeiigasiylnity malcorai ae Seieuiomeateee fp eatetenea esate ony Exvopeasee titelag [> tergrtstseenemnns orcs to am as fast theo he can fom, 4 Honsuppot lg Ban apTonmately 90 Seores Go." Repeat a second a fhe, dove to buttocks) Seared sever [eagiaencatamae [+ ary Eas erate ee | kate oreremerns Rocesy sims em |* Ameomdun mere maninirs oe Senge dee ime Eileen a eee eae Sa eae [mak oie beee | een eo me STE Ree! | ere | the other foot. Repeat a second trial. 3. Arms flexed and swing forward to produce force arn e aig aguas pees ET a tee agora [Ronzteemecunstn. tee, | Bie evn, [Meecdte mamas es |, Srnec per pmavernepend Base Re ice iene [beeen bee a eee aaa ski Materials Directions Performance Criteria ial 1 | wia2 | score 5. Horizontal | A minimum of 10. | Marke starting ine onthe floor | 1. Peparatry movement includes flexion ofboth Simp | foetof lene Have the cid start burial thee Inees with ams extended behind bod) snoceand tape | Telthochitdto jumps ar apheor [Arar entend Tort forward and upriard the can. Repeat esand tal ‘eachng ful extension above the nese 3._Take off and ladon both feet simutoneouay pers are ras downward uring landing Skil Sore [5 side [Aminimum af | face the cones 25 fet apart.on top |. Body tuned sderaye vo shoulder are aligned Biewtotaeae | of sing ante ont hee with she line on the face ‘pace atraiaht | fosida from one cone to the cther | =—Rstep sideways wth led foo lowed ys ies and anda Repeat 9 cond tia Sige ofthe taling Toot toa palnt nex te he 3A minimum oF our cortinuows Rep ade GEE feltheright A minimum af ou? eainuoe RapAS A forhelet Sailors Locomotor Subtest Raw Score (sum ofthe 6 skill scores) ‘Object Control Subtest ska Materials rectors Performance Citra walt | tat2 | Score 1 tng s | Acinch igh] cee al on twat ow te 1 Dornot hand gi bat above rondomara Eisotoy |SatlSeuaietse"| Ohiécterinat whimecsistone™ |" Rom Soro" |eetating ice | Stal Ropes ascend Wks [Repeat Say aa aay {eric pal ig ad ie ison Do arses ight oo fot Scones Bile P saiorey | Anke Wied | fl malo be ea ow Coc lh oe ta el Brose” | Bayseundbat | tnerathout neve sriar in, [cacao ard sox Terthlrnags, | ig Shand ondthen sopby [Spans a Saas Noscaumteon | cubiog nebai Rees accor ia, [¥ Bale sree n nt irda ° Potash ao El fora ee Rint ee fe vy oro eet sis sta Materials Directions Perfomance Citerin ialt | tiel2 | Score sch | aingtee | Mor off tw nes 15 fet pgrt-Te_ | Peparaon phase here and ein ront of iS etot| Gulden re inetd er |” the bed and eo fd Gearspce and | Snite ater fwrine bal undersand[7>Armcened whe ey rhe BATT tee Srey jote altos | bu Simin foci ore pest Telok at gy an - ‘to catch the ball with both hends. Only: eee een ‘Sates lons tt ste between Be ‘his soit ae be Repeat Sted al Sta Score “tes Yn tin] Mak off oe 30 fanny Fore. [fad coninous approach 1 eb Hist plygaing, | Maes! ineSs acca | Rskcnts seeceh wo Srsocter balla." | all Place the ballon top of tebean- |* feluciemect ne CoP Mmmesansy Pr ecg: 20 feet | gon tee cere mal al” Nong fot Saved wen WE OTRAS Geeimeon| Medios antwattrine. | ROMA ” Sieticsmeniste: |r tetta inpateteel eater Sond a Seasortoe Stal core . Owetans Aeris balla wil | Aachen aftape on te for 29 |. Wind insted wih downed overt row" |iowardatiecto! | fetotayal he feceigsere, |” otha ean SShndthe Ilotine acng he Wek. | Rote pani GUAT pa wre tahiti ing teal (Roch a Rua apt whe e the wall Repeat a second tril ‘Weight i vansfered by stepping withthe Foot plate ha rough Folvoogh beyond bl lee dno ‘on he boy ear he nonpstara a Saco © Und [Atos bal for] Se the wo cone apts wallso [1 Plead han via down ap bck aching Ra"™™ | Gielen agesSios | agaecTaclapreaitaceaece’ | boku tan when nw sons fuotea ora | often te oo fee womthe, [sues oer wih ot opps he pe dette iste, | watek ese relat toa | Sue aruda gre ogeste he eee ona) at gestae hones pare te mee es Releases bal close tothe floor so ball does nat Secret more thans hes gh sta cre ‘bec Conte Subtest Raw Score Gum ofthe 6 Hl sears) |

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