TRANSITION TO KINDERGARTEN
Preparing for each child with signed parental permission
Completed by:
Receiving School District:
Child’s Name (Last, First):
Preschool Site:
Preschool Phone Number:
The child lives with:
Date:
Follow-up Suggested:
Generally:
The child separates easily from parent
The child makes eye contact when communicating
When expected, the child sits in their seat/circle
The child responds to the teacher
The child stays on task
The child is cooperative
The child is not disruptive
The family is involved in the child’s education
The child’s primary language is English
Language spoken in the home is English
The child has age-appropriate self-help skills
(Check One)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Services
The child has an existing IEP
The child receives Occupational Therapy
The child receives Physical Therapy
The child receives speech services
The child receives developmental services
The child has wrap around services/TSS
The child has behavior support plan
The child has health needs/allergies
(LIST)
Other:
Wears glasses
Hearing impaired
Do you think this child needs to be monitored for additional services?
Preschool Classroom School Days Missed
0-10
10-20
20 or more
Title:
not applicable
Home-base services, attendance not appicable
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
Yes
Yes
Yes
No
No
No