Preschool Teacher'S Recommendation Page 3
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4PHYSICAL DEVELOPMENT
OUTSTANDING
AGE APPROPRIATE
NEEDS DEVELOPMENT
Small muscle control and coordination
_________________________________________________________________
Large muscle control and coordination
__________________________________________________________________
Speech development (articulation)
_________________________________________________________________
Has the student been referred to a school counselor or to an outside professional for:
(Circle answer.)
Academic diffi culties
Yes
No
Emotional issues
Yes
No
Social challenges
Yes
No
Behavioral diffi culties
Yes
No
Is distracted easily
Yes
No
Exhibits impulsivity
Yes
No
Is easily frustrated
Yes
No
COMMENTS:
Has the student demonstrated any of the behaviors or challenges listed below?
Answer by writing U (usually) S (sometimes) R (rarely) N (Never).
_____________1. Clumsiness
_____________10. Diffi culty with basic concepts such as size,
shape, color
_____________2. Poor balance
_____________11. Unusual restlessness (hyperactivity)
_____________3. Diffi culty manipulating small objects
_____________12. Diffi culty staying on task
_____________4. Awkwardness with running, jumping, or climbing
_____________13. Diffi culty changing activities
_____________5. Trouble learning to tie shoes, button shirts, or
performing other self-help activities
_____________14. Constant repetition of an idea, inability to
move on to a new idea
_____________6. Avoidance of drawing or tracing
_____________15. Prone to sudden and extreme mood changes
_____________7. Trouble remembering the alphabet or
days of the week
_____________16. Hard to manage, has temper tantrums
_____________8. Poor memory for what should be routine
_____________17. Separation anxiety
(everyday) procedures
_____________9. Diffi culty with cause and effect, sequencing,
and counting
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