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