[PDF]Calvary Temple Christian Academy - Rackcdn.com5c841bb5e6237df62951-b3e5df06645780bb22231cb44b023e76.r18.cf2.rackcdn.co...
1 downloads
178 Views
500KB Size
CALVARY ACADEMY
1133 E County Line Rd Lakewood NJ 08701-2196 Phone: 732-363-3633 Fax: 732-363-7337 Business Office: 732-363-1655 Web: www.calvaryacademy.org
Kindergarten Questionnaire/Reference Name of Student:
Date: _________________________
Name of Present School/Daycare: ___________________________________________________________________ Address: _______________________________________________________________________________________ Name of Teacher:
Teacher Signature: ___________________________
The parents of the student listed above have requested that Calvary Academy consider their son/daughter for admission. The school admissions office would appreciate your prompt response to the information requested. Your assistance is essential in evaluating the applicant in relation to our academic program. Please complete the appropriate section and mail this form in the enclosed envelope. Thank you for your assistance in helping us become better acquainted with this student.
To be completed by a former teacher or daycare provider (Sunday School teachers may be considered only if a pre-school teacher is not available) 1. Does this child have any health, emotional, or psychological problems?
Yes No Not Sure
(If yes please describe in the comment section)
2. Does he/she have normal vision?
Yes No Not Sure
3. Does he/she have normal hearing?
Yes No Not Sure
4. Is this child moody? (depressed at times, exhilarated at times)
Yes No Not Sure
5. Does this child exhibit temper tantrums?
Yes No Not Sure
6. Normally, does this child obey his/her parents?
Yes No Not Sure
7. Is this child respectful when spoken to by parents & adults?
Yes No Not Sure
8. Is he/she overly aggressive (fighting, pushing, demanding)?
Yes No Not Sure
9. Can others easily understand the child when he/she speaks?
Yes No Not Sure
10. Does the child pay attention to a short story when being read to?
Yes No Not Sure
11. Is the child able to color a picture beyond scribble?
Yes No Not Sure
Kindergarten Reference 2014/15
12. Is the child able to zip or button up a jacket?
Yes No Not Sure
13. Is the child able to easily detach from the parent when entering the class?
Yes No Not Sure
14. Is the child able to put together a simple puzzle?
Yes No Not Sure
15. Is the child able to listen to and follow 2-step instructions?
Yes No Not Sure
16. Can the child hold a pencil correctly?
Yes No Not Sure
17. Can the child cut with scissors?
Yes No Not Sure
18. Can the child recognize and name at least 6 colors?
Yes No Not Sure
19. Can the child take care of his/her own bathroom needs?
Yes No Not Sure
20. Can the child recite and follow classroom rules & procedures?
Yes No Not Sure
21. Is the child able to attend a task for several minutes or until finished?
Yes No Not Sure
22. Does your preschool provide any Christian training?
Yes No
23. Does this child show any interest in spiritual matters?
Yes No Not Sure
24. Has the child been excessively absent/tardy?
Yes No Not Sure
Circle the words that best describe this child: very quiet
sometimes shy
somewhat active
highly active
friendly
cautious
risk-taker
talkative
aggressive
curious
moody
creative
Comments:
This child appears to be ready for kindergarten.
Yes
No
Questionable
Childhood should be a journey not a race. st
Children should be 5 years old on or before September 1 .
Kindergarten Reference 2014/15