Student Profile
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Student Name
*
First Name
Last Name
Date of Birth
*
 -
Day
 -
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Age
*
Father Name
*
First Name
Last Name
Mother Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Asessor's Name
*
Assessment
1. Communication and Social Skills
Rows
Execllent (5)
Average (3)
Poor (0)
score
Response when called
Greets confidently
Clarity in speech
Answers simple questions
Maintaining eye contact
Seperates compfortably from parent
Shows confidence
2. Identification Skills
Rows
Correctly Identified
Identified with support
Failed to identify
Score
Colours
Alphabets
Numbers
Shapes
Animals
Fruits
Vegetables
Birds
Body Parts
Vehicles
Everyday Objects
Flowers
Professionals
3. Activity Identification Skills
Rows
Correctly Identified
Identified with Support
Failed to Identify
Score
Brushing Teeth
Washing Hands
Eating an Apple
Drinking Water
Eating Food
Walking
Running
Cycling
Swimming
Sleeping
4. Cognitive and Memory Skills
Rows
Excellent
Good
Average
Poor
Score
Picture Memory
Object Recall
Attention and concentration
Overall Evaluation
Rows
Score
Communication Skill (Max. 35)
Identification Skill (Max. 65)
Activity Identification Skill (Max. 60)
Cognitive and Memory Skill (Max. 15)
Total Score
(score out of 140)
Percentage (%)
*
Level
*
Recommendation
*
Assessor's Observation
Reviews and Approval
Vice Principal's Observation
Principal's Observation
Director's Observation
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