Standardized Assessment Report Form

Use the standardized assessment that your cooperating teacher uses to develop IEPs. These
must align with the appropriate and current version of the assessment adopted by the State of
Texas (Brigance, CLASS, etc.).
Student's Initials: L.P.

Date: 3-29-16

Age: 4
Grade: PPCD
Gender: Male
Instruments Administered: Brigance Screen III for 3-5 year olds

Recommended Objectives:
(Example: TLW identify the main idea in 3 out of 4 passages with an accuracy rate of 75%.)
The student will comply with adult directives 70% of the time.
Describe 5 activities to be implemented in class based on the findings of the assessment and your
cooperating teacher`s recommendations. Include rationale for using each activity:
(Example: 1. The student will dictate a short story and then identify the main idea. 2. The student
will choose a chapter out of his favorite book and identify the main idea.)
1. The student will answer questions when asked. 2. The student will draw shapes other than circles when
prompted.
3. The student will be mostly attentive to adult directed activities. 4. The student will follow three-step
directions.
5. The student will discriminate different shape forms.

Comments:
The students score struggled because the he was having a hard time complying with the directives from
the teacher.
There was a lot of no,no,no when asked to complete a task and on one specific section where the
student was directed to draw specific shapes he replied with no, just a circle, just a circle

Haley Lacativo

Barbara Keith

Student Teacher

Cooperating Teacher