Pre-K3 Admissions Questionnaire
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Please answer the following questions about your child to help us understand their preparedness for our Pre-K3 program.
Parent/Guardian Name
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required
First Name
Last Name
Home Address
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required
Phone Number
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required
Email Address
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required
Student's Name
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required
First Name
Last Name
Student's Birthdate
Must contain a date in M/D/YYYY format
Can name familiar items (ex. tree, table, book)
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required
Yes, regularly
Sometimes
Not yet
Understands the idea of “mine” and “his” or “hers"
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required
Yes, regularly
Sometimes
Not yet
Can name familiar items (ex. tree, table, book)
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required
Yes, regularly
Sometimes
Not yet
Can identify body parts such as eyes, nose, hair, feet, etc.
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required
Yes, regularly
Sometimes
Not yet
Understands words like “in,” “on,” and “under”
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required
Yes, regularly
Sometimes
Not yet
Says their first name, age, and gender when asked
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required
Yes, regularly
Sometimes
Not yet
Says words like “I,” “me,” “we,” and “you” and some plurals (cars, dogs, cats)
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required
Yes, regularly
Sometimes
Not yet
Can carry on a conversation using sentences
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required
Yes, regularly
Sometimes
Not yet
Can work toys with buttons, levers, and moving parts
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required
Yes, regularly
Sometimes
Not yet
Plays make-believe with dolls, animals, and people
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required
Yes, regularly
Sometimes
Not yet
Does puzzles with 3 or 4 pieces
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required
Yes, regularly
Sometimes
Not yet
Copies a circle with a pencil or crayon
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required
Yes, regularly
Sometimes
Not yet
Turns book pages one at a time
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required
Yes, regularly
Sometimes
Not yet
Builds towers of more than 6 blocks
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required
Yes, regularly
Sometimes
Not yet
Screws and unscrews jar lids or turns door handle
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required
Yes, regularly
Sometimes
Not yet
Can run and climb
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required
Yes, regularly
Sometimes
Not yet
Walks up and down stairs, one foot on each step
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required
Yes, regularly
Sometimes
Not yet
Can put on and take off shirt or jacket
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required
Yes, regularly
Sometimes
Not yet
Takes turns in games
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required
Yes, regularly
Sometimes
Not yet
Follows instructions with 2 or 3 steps (i.e. put the toy down and get a book)
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required
Yes, regularly
Sometimes
Not yet
Does your child talk well enough for strangers to understand most of the time?
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required
Yes
No
Is your child fully potty-trained?
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required
Yes
No
If you answered no, please provide information about level of training (frequency of accidents, time spent in diapers/pull-ups, etc.)
Is there anything else we need to know about your child?
Parent/Signature
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required
I understand this is a legal representation of my signature.
First Name
Last Name
I understand this is a legal representation of my signature.
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