Spanish
English
Casa
- Contacto
Programas
Inscribirse
Carreras
Socios
Testimonios
Preguntas más frecuentes
- Eventos
  - Comercial

Evaluación de 54 meses

CUESTIONARIO PARA PADRES
Queridos padres,

Ayúdenos a conocer a su hijo por llenando este formulario. Todas la información será confidencial. Nosotros será Use lo que nos dice a medida que comenzamos a conocer a su hijo y pagslunnorte Washingtonys to metroeet Holas/her nortemimires y To hmilpags hyometro/ her desarrollar. Por favor regreso eso a colegio como pronto como posible.

¡Muchas gracias!
El nombre del niño
Apodo del niño
Padres Nombres
Fecha
MM barra DD barra AAAA
Maestro del niño
¿Vive con su hijo?
- Ambos padres
- Monoparental
- Otros adultos
Por favor especifica
Enumere los nombres y edades de otras personas que viven en su hogar. (Esto me ayudará a escribir los nombres correctamente en las imágenes que su hijo dibuje sobre su familia).
Mascotas (nombre y tipo de animal)
Trabajo del padre
Profesión de la madre
¿Tiene su hijo una habitación propia?
- si
- No
Si no es así, ¿con quién comparte habitación?
¿Cuáles son las actividades e intereses de juego favoritos de su hijo?
¿El niño usa palabras especiales para ir al baño?
Programas de televisión favoritos del niño
Horas diarias dedicadas a ver televisión
¿Suele jugar su hijo?
- ¿Solo?
- ¿Con un amigo?
- ¿Con algunos amigos?
- con niños más pequeños?
- con niños mayores?
- con niños de la misma edad?
¿Tiene el niño miedos decididos? ¿Entonces qué?
¿Qué responsabilidades tiene su hijo en casa?
¿Cuál es tu mayor problema de disciplina?
¿Cuál es el cuento, tipo de cuento o libro favorito de su hijo?
¿Tuvo su hijo un parto prematuro o difícil que pueda indicar retrasos cognitivos?
¿Es el inglés el idioma principal que se habla en el hogar? Si no es así, ¿qué es?
¿Su hijo habla inglés? ¿Entender inglés?
¿Cómo se siente su hijo al venir a la escuela?
¿Qué espera que su hijo aprenda este año?
Haga comentarios sobre cualquier otra cosa que crea que necesito saber sobre su hijo.
Nuestro objetivo es fomentar un sentido de pertenencia, promover el aprecio por los demás y enriquecer las experiencias de los niños al integrar en nuestro plan de estudios actividades e información que reflejen los antecedentes individuales de nuestros niños. One way we can do this is by learning about each child?s family background, celebrated holidays, and traditions. Please take a few minutes to share with us your special family days or activities and how they are carried out in your home.
¿Qué idiomas además del inglés hablan los miembros de la familia que rodean a su hijo?
¿Su hijo tiene alguna discapacidad física o de aprendizaje? Si es así, describa
Are there any family members with disabilities that may directly impact your child?s daily life (for example, a deaf grandparent, wheelchair bound parent, etc.)?
What information about your family?s background and culture would you like to share with us?
¿Cuáles son las fiestas, los días especiales o las tradiciones en las que participa su familia?
¿Hay alimentos, canciones, elementos o símbolos especiales que incluya en su celebración de momentos familiares especiales?
¿Tiene su hijo alguna restricción dietética debido a alergias, intolerancias, preferencias familiares o religiosas? Si es así, ¿qué está restringido?
Are there any activities from your family?s culture or traditions that you would like to share with your child?s classroom?
Are there any activities from your family?s culture or traditions that you would like to share with your child?s classroom?
Haga comentarios sobre cualquier otra cosa que crea que necesito saber sobre su hijo.
¿Cuáles son sus puntos fuertes?
¿Cuáles son las áreas de debilidad? ¿En qué te gustaría que tu hijo mejorara?
My child learns best when the teacher is?.
My child does not work well with?
¿Cuál es la mejor forma de motivar a su hijo?
¿Qué esperas en YMIM?
How would you like to be involved with your child?s education?
What is your preferred method of communication (email, phone call, meeting, note?)___
Date ASQ Completed:
Child?s date of birth:
MM barra DD barra AAAA
Child's Gender
- Niño
- Niña
Person filling out Questionnaire
First Name
Middle Initial
Last name
Street Relationship to child:
Relacion hacía el niño:
- Parent
- Guardian
- Teacher
- Child Care Provider
- Grandparent or other relative
- Foster Parent
City :
State / Province:
Zip / Postal Code:
Country
Home telephone number:
Other telephone number:
Email Address
Name of the people assisting in questionnaire completion:
Program Information
Child ID #
Program ID #
Program Name
Puntos importantes para recordar:
- Pruebe cada actividad con su hijo antes de marcar una respuesta.
- Haga que completar este cuestionario sea un juego divertido para usted y su hijo.
- Asegúrese de que su hijo no esté cansado ni tenga hambre.
- Please return this questionnaire by ________________________
Notes
1. Does your child tell you at least two things about common objects? For example, if you say to you chid, ? tell me about your bal. ? does se say something like, ?Its? round. It?s round. I throw it. Its?s big?
- si
- Sometime
- Aún no
2. Does your child use all of the words in a sentence ( for example, ? a, ? ?the?,?am,? ?is? and ? are ?) to make complete sentences, such as ? I am going to the park,? ?Is there a top to play with?? Or ? Are you coming, too??
- si
- Sometime
- Aún no
3. Does your child use endings of words, such as ?-s," "-ed,? and ?-ing"? For example, does your child say things like, ?I see two cats,? ?lam playing,? or ?I kicked the ball??
- si
- Sometime
- Aún no
4. Without giving your child help by pointing or repeating directions, does he follow three directions that are unrelated to one another? Give all three directions before your child starts. For example, you may ask your child, ?Clap your hands, walk to the door, and sit down,? or "Give me the pen, open the book, and stand up.
- si
- Sometime
- Aún no
5. Does your child use four- and five-word sentences? For example, does your child say, ?! want the car?? Please write an example:
6. When talking about something that already happened, does your child use words that end in ?-ed,? such as ?walked,? ?jumped,? or ?played?? Ask your child questions, such as ?How did you get to the store?? (?We walked.?) ?What did you do at your friend??s house?? (?We played.?) Please write an example:
Total de comunicación
Gross Motors
1. Does your child hop up and down on either the right foot or the left foot at least one time without losing her balance or falling?
- si
- A veces
- Aún no
2. While standing, does your child throw a ball overhand in the direction of a person standing at least 6 feet away? To throw _t overhand, your child must raise his arm to shoulder height and throw the ball forward. (Dropping the ball or throwing the ball underhand should be scored as ?not yet.)
- si
- A veces
- Aún no
3. Does your child jump forward a distance of 20 inches from a standing position, starting with her feet together?
- si
- A veces
- Aún no
4. Does your child catch a large ball with both hands? should stand about 5 feet away and give your child two or ant three tries before you mark the answer.
- si
- A veces
- Aún no
5. Without holding onto anything, does your child stand on one foot for at least 5 seconds without losing her balance and putting her foot down? (You may give your child two or ' three tries before you mark the answer.)
- si
- A veces
- Aún no
6. Does your child walk on his tiptoes for 15 feet (about the length of a large car)? (You may show him how to do this.)
- si
- A veces
- Aún no
Gross Motor Total
Fine Motor
1. Using the shapes below to look at, does your child copy at least three shapes onto a large piece of paper using a pencil, crayon, or pen, with- out tracing? (Your child?s drawings should look similar to the design of the shapes below, but they may be different in size.)
- si
- A veces
- Aún no
2. Does your child unbutton one or more buttons? (Your child may use his own clothing or a doll?s clothing.)
- si
- A veces
- Aún no
3. Does your child color mostly within the lines in a coloring book or within the lines of a 2-inch circle that you draw? (Your child should not go more than 1/4 inch outside the lines on most of the picture.)
- si
- A veces
- Aún no
4. Ask your child to trace on the line below with a pencil. Does your child trace on the line without going off the line more than two times? (Mark ?sometimes? if your child goes off the line three times.)
- si
- A veces
- Aún no
5. Ask your child to draw a picture of a person on a blank sheet of paper. You may ask your child, ?Draw a picture of a girl or a boy.? If your child draws a person with head, body, arms, and legs, mark ?yes.? If your child draws a person with only three parts (head, body, arms, or legs), mark ?sometimes.? If your child draws a person with two or fewer parts (head, body, arms, or legs), mark ?not yet.? Be sure to include the sheet of paper with your child?s drawing with this questionnaire.
- si
- A veces
- Aún no
6. Draw a line across a piece of paper. Using child-safe Um i scissors does your child cut the paper in half on more or less straight line, making the blades group _ and down? (Carefully watch your child's use of scissors for safety reasons.)
- si
- A veces
- Aún no
Fine Motor Total
Problem Solving
1. When shown objects and asked, ?What color is this?? does your child name five different colors, like red, blue, yellow, orange, black, white, or pink? (Mark ?yes? only if your child answers the question correctly using five colors.)
- si
- A veces
- Aún no
2. Does your child dress up and ?play-act,? pretending to be someone or something else? For example, your child may dress up in different clothes and pretend to be a mommy, daddy, brother, sister, or an imaginary animal or figure.
- si
- A veces
- Aún no
3. If you place five objects in front of your child, can she count them by saying, ?One, two, three, four, five? in order? (Ask this question without providing help by pointing, gesturing, or naming.)
- si
- A veces
- Aún no
4. When asked, ?Which circle is smallest?? does your child point to the ) a smallest circle? (Ask this question without providing help by pointing, gesturing, or looking at the smallest circle.)
- si
- A veces
- Aún no
5. Does you child count up to 15 without making mistakes? If so, mark ?yes? If your child counts to 12 without making mistakes, ,ark ?some-times.?
- si
- A veces
- Aún no
6. Does your child know the names of numbers? (Mark ?yes? if he identifies the three numbers below. Mark ?sometimes? if he identifies two numbers.)
- si
- A veces
- Aún no
Problem Solving Total
Personal Social
1. Does your child wash her hands using soap and water and dry off withna towel without help?
- si
- A veces
- Aún no
1. Does your child wash her hands using soap and water and dry off withna towel without help?
- si
- A veces
- Aún no
2. Does your child tell you the names of two or more playmates, not including brothers and sisters? (Ask this question without providing help by suggesting names of playmates or friends.)
- si
- A veces
- Aún no
3. Does your child brush his teeth by putting toothpaste on the toothbrush and brushing all of his teeth without help? (You may still need to check and re brush your child's teeth.)
- si
- A veces
- Aún no
4. Does your child serve herself, taking food from one container to another, using utensils? (For example, does your child use a large spoon to scoop applesauce from a jar into a bowl?)
- si
- A veces
- Aún no
5. Does your child tell you at least four of the following? Please mark the items your child knows.
- a. First name
- b. Age
- c. City she lives in
- d. Last Name
- e. Boy or Girl
- f. Telephone Number
6. Does your child dress or undress himself without help (except for snaps, buttons, and zippers)?
- si
- A veces
- Not yet
Personal Social Total
1. Do you think your child hears well? If no, explain:
2. Do you think your child talks like other children her age? If no explain
3. Can you understand most of water what your child says? If no, explain
4. Can other people understand most of what your child says?If no, explain
5. Do you think your child walks, runs, and climbs like other children his age? If no, explain:
6. Does either parent have a family history of childhood deafness or hearing impairment? If yes, explain:
7. Do you have any concerns about your child?s vision? If yes, explain:
8. Has your child had any medical problems in the last several months? If yes, explain:
9. Do you have any concerns about your child?s behavior? If yes, explain:
10. Does anything about your child worry you? If yes, explain:

Δ

Evaluación de 54 meses

CUESTIONARIO PARA PADRES

Person filling out Questionnaire

Program Information

Puntos importantes para recordar:

Gross Motors

Fine Motor

Problem Solving

Personal Social