Admission screening for kids – Education Board Of Vocational Training & Development

Admission screening for kids

Father's Name

Mother's Name

Child's Name

Date of Birth

Refered by doctor

ADHD

Autism

Dyslexia

Dysgraphia

Dyscalculia

Reading

Writing

Brief history

Studing in any school?

Yes

School Name

Has poor eye contact?

Normal

Mild

Moderate

Severe

Remains aloof?

Normal

Mild

Moderate

Severe

Unable to relate to people?

Normal

Mild

Moderate

Severe

Shows inappropriate social response.

Normal

Mild

Moderate

Severe

Repetative play activity.

Normal

Mild

Moderate

Severe

Doesn't maintain peer relationship.

Normal

Mild

Moderate

Severe

Unusual noise making.

Normal

Mild

Moderate

Severe

Meaningless words.

Normal

Mild

Moderate

Severe

Stares into space for a long period of time.

Normal

Mild

Moderate

Severe

Unusual smelling, tasting & touching objects.

Normal

Mild

Moderate

Severe

Does the child draw simple shapes if you ask him to?

Yes

Does the child safely navigate the environment when you take the child to the park?

Yes

Does the child imitate body movements when you perform a song in front of him?

Yes

Does the child follow the rhythm when you clap a bit?

Yes

Does the child participate in art class at school?

Yes

Does the child shorten objects when you do worksheets like differentiating color?

Yes

Does the child maintain balance if you ask him to follow a daily routine?

Yes

Does the child ask for food if he is hungry?

Yes

Does the child enjoy playing in groups?

Yes

Does the child track the ball when you play with him with a ball?

Yes

Does the child enjoy the texture of the grass when he plays in the park?

Yes

Does the child independently feed with a spoon?

Yes

Does the child quickly respond if you ask anything?

Yes

Does the child enjoy wearing a variety material if you give him something?

Yes

Does the child follow the instructions step by step if you ask him to complete a task?

Yes

Does the child show interest in trying new foods when you take him to a restaurant?

Yes

Does the child have any problems to playing on sand?

Yes

Does the child independently drink If you give him a cup of milk?

Yes

Does the child differentiate if you ask to shorten fruits and flowers?

Yes

Does the child settle down easily if he starts crying?

Yes

Does the child point out body parts if you ask him to?

Yes

Does the child independently wash his hands if they’re messy?

Yes

Is the child happy if his mother hugs him?

Yes

Does the child ask for help if she faces any problems?

Yes

Does the child manipulate playdoh if you ask him to make an object?

Yes

Does the child independently dress himself if you leave him to do so?

Yes

Does the child identify familiar objects if you ask him?

Yes

Does the child enjoy swinging and sliding when you take her to the playground?

Yes

Does the child copy building blocks independently?

Yes

Does the child identify simple shapes If you show him a shape chart?

Yes

Restless or overactive.

Not at all

Just a little

Pretty much

Very much

Excitable, impulsive.

Not at all

Just a little

Pretty much

Very much

Disturbs other children.

Not at all

Just a little

Pretty much

Very much

Fails to finish things, no starts.

Not at all

Just a little

Pretty much

Very much

Constantly fidgeting / short attention span.

Not at all

Just a little

Pretty much

Very much

Inattentive, easily distracted.

Not at all

Just a little

Pretty much

Very much

Demands must be met immediately, easily frustrated.

Not at all

Just a little

Pretty much

Very much

Cries often and easily.

Not at all

Just a little

Pretty much

Very much

Mood changes quickly and drastically.

Not at all

Just a little

Pretty much

Very much

Temper tantrums, explosive and unpredictable behavior.

Not at all

Just a little

Pretty much

Very much

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