IMEP School Readiness Checklist

Student Name:

First NameLast Name

D.O.B.:

Date

PFS

YesNo

Today

Date

Age in days

Age in Months

Double check that this number fits within the age window shown in the form name.

Region (see image above for help)

Scale for scoring:

“+” - Does satisfactorily for age (Mastery) *Based on the US Dept. of Ed. Early Childhood Educational Outcomes
“i” - Improving / Making genuine attempts
“-” - Needs Some Improvement / Not Doing

(Leave blank if skill is not assessed)

Social and Emotional Foundations (6)

	Entrance	Exit
Verbalizes own feelings and ideas.
Works and plays cooperatively with other children.
Works cooperatively with adults.
Can wait to have needs satisfied.
Takes initiative in learning.
Participates in group situation(s).

Total the number of "+" from the Entrance column.

Total the number of "i"s from the Entrance column.

Total the number of "+" from the Exit column.

Total the number of "i"s from the Exit column.

Type any notes from this section you'd like to include with this submission.

Mathematical Thinking and Expression (7)

	Entrance	Exit
Can count from 1 to 10. Can count from 1 to 20. (This is mastery) Can count higher than 20.
Recognizes numbers 1 to 10.
Child counts objects to 10 and describes how many. (Ex. Have child count a number of objects and then ask them, "How many is that?" Appropriate response would be the number of objects, not a recounting.)
Can identify at least 4 shapes (ex. Square, circle, triangle, rectangle...).
Can draw at least 4 shapes (ex. Square, circle, triangle, rectangle...).
Sorts, compares, or classifies objects by attributes such as size, quantity, shape, or color.
Knows the primary colors.

Total the number of "+" from the Entrance column.

Total the number of "i"s from the Entrance column.

Total the number of "+" from the Exit column.

Total the number of "i"s from the Exit column.

Type any notes from this section you'd like to include with this submission.

Language and Reading Development (10)

	Entrance	Exit
Knows his/her full name?
Speaks in complete sentences.
Listens to directions for games and activities.
Follows through when given multi-step (no more than 3) directions.
Listens to stories for at least 10 minutes.
Follows left to right progression.
Verbalizes songs and fingerplays.
Recognizes name in print.
Recognizes some upper and lower case letters.
Can describe pictures in books using detail.

Total the number of "+" from the Entrance column.

Total the number of "i"s from the Entrance column.

Total the number of "+" from the Exit column.

Total the number of "i"s from the Exit column.

Type any notes from this section you'd like to include with this submission. (This is optional)

Fine Motor (Writing) (5)

	Entrance	Exit
Uses pencil, crayon, paintbrush, etc. with control.
Prints name. (At least first name)
Creates an illustration and tells about it.
Uses scissors with control.
Works a puzzle of 10 or more pieces.

Total the number of "+" from the Entrance column.

Total the number of "i"s from the Entrance column.

Total the number of "+" from the Exit column.

Total the number of "i"s from the Exit column.

Type any notes from this section you'd like to include with this submission. (This is optional)

Ball Handling

	Entrance	Exit
Throws
Catches
Bounces

Note: Use the "Ball Handling" table above to mark ball handling skills mastery or progress and then use that info to complete the first line of the Physical Health and Growth table below.

Physical Health and Growth (5)

	Entrance	Exit
Ball handling (mastery here requires at least 2 of 3 checks from above)
Demonstrates coordination and balance in active / gross motor play (run, jump, climb).
Claps and marches in time to music.
Identifies and locates body parts.
Takes care of bathroom needs.

Total the number of "+" from the Entrance column (from the Physical Health and Growth table only).

Total the number of "i"s from the Entrance column (from the Physical Health and Growth table only).

Total the number of "+" from the Exit column (from the Physical Health and Growth table only).

Total the number of "i"s from the Exit column (from the Physical Health and Growth table only).

Type any notes from this section you'd like to include with this submission. (This is optional)

Name of Staff Completing*

Staff email*

example@example.com

Skills Mastered (this is an automatic count of all the "+" from above)

Proficient =Mastery in 20 of 33 skills.
There are three checklist ratings described below to be entered into the Preschool Tracking Form:

(Y) = Yes (20 of 33 skills mastered)
(I) = In Progress (9 to 19 of the 33 skills mastered)
(N) = Not Yet, (0 to 8 skills mastered)
Unknown = not yet determined or other reason not yet assessed

Proficient?

Notes / Concerns / Recommendations