Parent/Guardian Name Email: Section 1A: Pre-K Student Profile Student Name: MSIS Number/ID: School/Site: District: Date of Teacher: Gender: Race: Street Address: College and Career Readiness Anchor Standards Performance Behavior Instructions: Indicate the total number of performance standards that Instructions: Check if documentation is applicable & were indicated as code 1 (needs development) in each domain on the available. College and Career Readiness Anchor Standards Observation Checklist for Four Year Old Children. Attendance Special Population School Year Days Present / Absent Instructions: if applicable to student. Special Education / IEP 504 List last 3 schools attended and dates. ELL (complete Appendix B) Speech/Language Other: Screener(s) Kindergarten Readiness Assessment Scores Instructions: Indicate the name of each screener used in the classroom and the screener’s recommended cut score. Indicate Instructions: Fill in the chart below based on student scores on the MKAS2 the date of the screener and the student’s score. Assessment. --------------------------------------------------------------------- Hearing/Vision Screener --------------------------------------------------------------------- Form Completed By: Date of Completion:
Section 1A: Pre-K Student Profile Student Name: MSIS Number/ID: School/Site: District: Date of Teacher: Gender: Race: Parent/Guardian Name Email: Street Address: College and Career Readiness Anchor Standards Performance Instructions: Indicate the total number of performance standards that were indicated as code 1 (needs development) in each domain on the College and Career Readiness Anchor Standards Observation Checklist for Four Year Old Children. Behavior Instructions: Check if documentation is applicable & available. Attendance School Year Days Present / Absent List last 3 schools attended and dates. Special Population Instructions: if applicable to student. Special Education / IEP 504 ELL (complete Appendix B) Speech/Language Other: Kindergarten Readiness Assessment Scores Instructions: Fill in the chart below based on student scores on the MKAS2 Assessment. Screener(s) Instructions: Indicate the name of each screener used in the classroom and the screener’s recommended cut score. Indicate the date of the screener and the student’s score. --------------------------------------------------------------------- --------------------------------------------------------------------- Hearing/Vision Screener Form Completed By: Date of Completion:
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