VPK Student Assessment Form
Please complete this form to assess the progress of VPK students across key learning domains.
Student Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Teacher/Assessor Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Literacy Skills Assessment
*
Rows
Not Yet
Emerging
Proficient
Recognizes letters
1
2
3
Identifies sounds
4
5
6
Understands stories
7
8
9
Mathematical Skills Assessment
*
Rows
Not Yet
Emerging
Proficient
Counts to 20
10
11
12
Recognizes shapes
13
14
15
Sorts objects by attributes
16
17
18
Social-Emotional Development Assessment
*
Rows
Not Yet
Emerging
Proficient
Shares with others
19
20
21
Follows directions
22
23
24
Expresses emotions appropriately
25
26
27
Physical Development Assessment
*
Rows
Not Yet
Emerging
Proficient
Gross motor skills
28
29
30
Fine motor skills
31
32
33
Self-care abilities
34
35
36
Overall Student Performance
*
1
2
3
4
5
Comments and Recommendations
Parent/Guardian Name
First Name
Last Name
Signature of Teacher/Assessor
*
Submit Assessment
Submit Assessment
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