Transition Skills Summary

KINDERGARTEN TRANSITION SKILLS SUMMARY

This summary is to support children as they move to and from preschool settings to kindergarten. Leaving a familiar setting such as home or child care may be difficult. Families and providers can offer information about what each child needs to feel confident and ready to learn. The information is confidential and completing the form is voluntary. The family and/or the provider may complete this form.

The purpose of this form is to promote a smooth transition to Kindergarten and/or for collaboration.

Child’s Name: DOB: Sex: M F

Address: Parents Name(s) Phone:

Family Structure: single parent foster other (describe) Existing Medical Conditions/Allergies: Yes No Please List:

Name used by Child: (Nickname)

Child Care/Day Care/Sitter/Provider’s Name: Contact # Program/Director/Title (if a Child Care Program):

Person filling out this form/Title: Date:

Name of Curriculum, if used:

Child Assessments used:

Consent for Release of Information: I give permission for ______to share all information pertinent to the (Service Provider) education & safety of my child, ______with ______. (Child’s Name) (School District / Program)

______(Parent/Guardian Signature) (School District of Residence)

______(Parent/Guardian Printed Name) (Elementary School)

______(Date)

Attendance Data This form will be sent to: Enrolled in program from ___ / ___ to ___ / ______Hours enrolled per week: ___ (District/Program Coordinator) Attends regularly (please circle): Yes/No ______Comments: (School District/Program) Transition Skills Checklist Preschool to Kindergarten/Referral

Child’s Name: ______Present Setting ______Assessments Used: Curriculum-Based Assessment, Portfolios, Observation, IEP Progress Reports, Anecdotal Notes, Work Samples, ASQ-SE, GGG, etc. Key: M-Most of the time D-Developing the skill N-Not at this time GROUP SETTING PRE-ACADEMIC Stops activity/action when directed Identifies red, blue, green, yellow, orange, black, brown, purple (circle) Works/plays independently for short Recognizes first name in print periods Follows daily routine & transitions easily Can describe a picture Gets teacher’s attention appropriately Counts to 10, using 1:1 correspondence Able to focus on a task for 5-10 minutes Prints first name in a group setting Follows established rules Recognizes words that rhyme when heard Moves through facility with group Recognizes words that begin w/same sound

SELF CARE COMMUNICATION Wipes / Blows nose independently Responds when name is called Brushes teeth daily Communicates wants and needs Washes hands independently Spoken words are understandable by others Uses the restroom independently Sings simple songs Left handed / Right handed Answers simple questions about a story Manages clothing independently Can follow simple directions (zips/buttons) Asks others for help when needed States first & last name when asked

SOCIAL MOTOR DEVELOPMENT Takes turns / works well with others Can hop, jump, climb, and balance Cooperates with others during play Functions appropriately in an area with others Adjusts easily to changes in routines Uses scissors (snips / cuts on a line) Expresses feelings & emotions Appropriately uses crayons, markers, or appropriately pencils on paper/other writing media Controls self in group Uses pincer grasp for writing/drawing Keeps hands to self With minimal adult help, works puzzles / builds with Legos or blocks Trusts adults ___yes ___no Plays on Outdoor/motor equipment Sample of Name Written by Child:

______1- Is the child currently receiving Special Education Services? Yes___ No ___ If Yes: Agency Name/Service Provider ______Contact Information: ______

2- May we contact them for additional details? Yes___ No ___

3- Does child have physical conditions or limitations? Please describe: (eye glasses, specialized equipment, etc.) ______

4- Has the child experienced difficulty or trauma causing social/emotional effects? (i.e., divorce, death in the family, illness, violence, separation from parent, etc.) Please describe: ______

______

5- Does the child exhibit behaviors that school personnel should know of and acknowledge to best serve the child? ______

6- How can the child be comforted and helped to cope with emotions? ______

7- How might we make this child most comfortable in the school setting (i.e., special seating, limited activity, select diet, daily rest time, etc.)? Accommodations recommended: ______

8- Family speaks a language other than English: Yes__ No__ If yes, language spoken at home ______Additional Information: ______(Attach additional pages if necessary) Revised 1/22/13