Early Learning Skills Assessment Form
Please complete this form to assess the early learning skills of the child. Select the response that best represents the child's current abilities across each skill area.
Child’s First and Last Name
*
First Name
Last Name
Age of Child (in years)
*
Communication Skills
*
Rows
Not Yet
Sometimes
Often
Always
Understands simple instructions
1
2
3
4
Uses words to express needs
5
6
7
8
Responds to questions appropriately
9
10
11
12
Social Interaction
*
Rows
Not Yet
Sometimes
Often
Always
Plays cooperatively with others
13
14
15
16
Shares toys or materials
17
18
19
20
Shows empathy toward peers
21
22
23
24
Fine Motor Skills
*
1
2
3
4
5
Gross Motor Skills
*
1
2
3
4
5
Early Literacy Skills
*
Rows
Not Yet
Sometimes
Often
Always
Recognizes letters
25
26
27
28
Enjoys being read to
29
30
31
32
Attempts to write or draw
33
34
35
36
Early Numeracy Skills
*
Rows
Not Yet
Sometimes
Often
Always
Counts objects up to 10
37
38
39
40
Recognizes basic shapes
41
42
43
44
Understands more/less concepts
45
46
47
48
Self-Help Skills
*
Rows
Not Yet
Sometimes
Often
Always
Dresses self with minimal help
49
50
51
52
Feeds self independently
53
54
55
56
Manages toileting needs
57
58
59
60
Attention and Focus
*
Easily distracted
1
2
3
4
Sustains attention
5
1 is Easily distracted, 5 is Sustains attention
Additional Observations (optional)
Submit Assessment
Should be Empty: