Inhome Aba Program Intake Packet Page 22
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27Behavior Matters, LLC
Teaching Skills for Success
(253) 686-6958;
Signature and Date
ACADEMIC:
Do you feel your child’s academic skill level is appropriate? Y/N
Would you like us to address academic skills development? Y/N
Can your child identify letters?
Lowercase ____all _____some _____none
Uppercase ____all_____some _____none
Can your child identify numbers?
Single digit (1-9) ____all ____some _____none
Counting:
Can count to 10 Y/N Can count to 20 Y/N Can count 20+
Y/N
Can your child count out a number of objects (e.g. Give me four pennies)
Up to 5 objects Y/N Up to 10 objects Y/N 10 + objects
Y/N
Can your child identity double digit numbers? 10-99 ___all ____some ____none
Can he/she complete simple addition math problems? (Single digit) Y/N
Can he/she complete simple subtraction problems? Y/N
Letter sounds:
Can your child: Identify letter sounds ____all ____some ____none Identify blends (e.g. sh, st, cr)
Y/N Can sound out words with blends Y/N
Reading:
Can read simple words (2-4 letter simple words – cat, dog, sat) Y/N
Can read longer words and sight words (there, just, jump) Y/N
Can sound out unknown words Y/N
Can read simple sentences Y/N
Can comprehend what he/she is reading (can understand and answer questions about what’s been
read) Y/N
Other number skills:
Reading Comments:
SELF CARE:
Does your child dress him/herself? ____Independently ____with some assistance ____ does not
dress self
Does your child bathe him/herself? ____Independently _____ with some assistance ____ does not
bathe self
Grooming (brushing teeth, combing hair) ____ independently ____some assistance ___does not
Does your child clean up after him/herself ____ independently ____ when asked ____ does not
Do you have safety concerns regarding your child’s activities at home? Y/N
Explain: ____________________________________________________________________
______________________________________________________________________
22
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business