Mid-Coast Preschool Services Development Screening Interview

Child's Name: Matthew Rasmussen Age 4yrs 4 mo. Date Dec 6, 1984

Four Years

Social:

1. How much does your child do for himself in dressing and washing up?

[X] Unbuttons and buttons clothing

[X] Washes hands and face

[X] Toilet trained day and night

[X] Cares for self at toilet mostly

2. How much does your child do for himself in eating?

[X] Spreads with knife soft things

3. Describe how he/she plays with children. gets upset w/ younger children interfering

[X] Understands taking turns/sharing

[X] Group play (2-3 children)

Gross Motor:

1. What does your child do when playing outside? Pretend play – Boats, Little puppy or Sandbox

[ ] Bounces and catches large ball -no

[ ] Pedals tricycle turning corners no – big wheel too large – snow on ground now

[X] Runs and climbs

[X] Hops on one foot

Fine Motor:

1. What does your child do with paper and pencil?

[X] Copies +

[X] Copies []

2. What kinds of toys does your child play with?

[X] Imitates bridge

[ ] Completes 6 piece puzzle

[X] Builds tower of 10 blocks

[X] Cuts with scissors

Mid-Coast Preschool Services

Developmental Screening Interview

Four years

Page 2

Language/Concepts:

1. How much does your child talk? very verbal

2. Can you give me an example of the kind of sentence he/she uses? Noah and Ethan are my very best friends

3. How well is he understood by others? very well

[X] Relates experiences, describes activities

[X] Names 3 Primary colors

[X] Says most sounds except r s th and l

[X] Repeats nursery rhyme or song for others

[X] Understood by strangers

Carolyn Rasmussen

Interviewer

 Mid-Coast Preschool Services Development Screening Interview

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