Professional Documents
Culture Documents
Name:
Observer:
Program:
Dates:
Directions:
Put a for items you see the child perform regularly. Put N for items where there is
no opportunity to observe. Leave all others blank.
Item
Evidence
Date
1. Self-Esteem
X
X
Completes a task
successfully
X Makes activity choices
without teachers help
X Stands up for own rights
10/16/14
20141016_081417
10/2/14
20141002_093334
10/16/14
20141016_081708
10/16/14
20141016_100532
11/16/14
11/7/14
20141107_160339
2. Emotional Competence
___Releases stressful feelings
in appropriate manner
X Expresses anger in words
rather than negative actions
___Can be calmed in
frightening situations
X Shows fondness, affection,
love towards others
10/17/14
20141017_161055
11/7/14
Page 1 of 4
11/7/14
11/7/14
4/16/15
Item
Evidence
Date
10/23/14
20141023_161019
10/16/14
20141016_094529
11/07/14
20141107_163233
10/08/14
20141008_160035
11/07/14
20141107_162944
10/03/14
20141003_102531
11/07/14
20141107_160419
11/07/14
20141107_160336
Displays 1-to-1
Correspondence
10/16/14
20141016_082036
Problem-solves with
concrete objects
3. Social Competence
X
X
10/14/14
20141014_161604
4. Physical Development
X
5. Cognitive Development
X
Page 2 of 4
10/17/14
20141017_154823
11/04/14
20141104_162331
4/16/15
Item
Evidence
Date
6. Spoken Language
___Listens but does not speak
Gives single-word, short
phrase responses
Takes part in conversations
Speaks in expanded
sentences
Asks questions
Can tell a story
10/02/14
20141002_085225
10/03/14
20141003_094643
10/07/14
10/23/14
Page 3 of 4
4/16/15
Item
him/herself
Evidence
picks up a toy cars. Child pushes the car around
the housekeeping area while making car noises.
Date
20141023_160030
Page 4 of 4
4/16/15