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Student Preference Assessment

Student Name: ________________________________!


DOB:_____________ Date Completed:_____________ !
Check all that apply:

Sensory Social
Activity
Reinforcers
Reinforcers
Reinforcers

¨  Swinging
q  Hugs
¨  Drawing

¨  Blowing Bubbles
q  Adult attention
¨  Paint

¨  Being Held
q  High Five
¨  Books

¨  Squeezes
q  Verbal Praise
¨  Computer

¨  Jumping
q  Thumbs up
¨  Ipad

¨  Roll up in a blanket
q  Applause
¨  Puzzles

¨  Jumping
q  Eye contact
¨  Water play

¨  Spinning
q  Hand Shake
¨  Sand play

¨  Back rub
q  1 on 1 time
¨  Musical toys

¨  Olfactory (smell)
q  Sit with adult
¨  Going for a walk

¨  Pressure
q  Tickles
¨  Dress up

¨  Other: q  Other: ¨  Other:


_______________ _____________ ________________
_______________ _____________ ________________
_______________ _____________ ________________
_______________
_____________
________________

Interests


Favorite:

¨  Animals
Drinks:____________________________
¨  Alphabet

_________________________________!
¨  Cars
Foods:____________________________
¨  Dolls
_________________________________!
¨  Dinosaurs

¨  Numbers
TV
¨  Shapes
Shows:____________________________
¨  Tools
_________________________________
¨  Trains
_________________________________!
¨  Trucks
Movies:___________________________
¨  Weather
_________________________________!
¨  Other:_________ Characters:_________________________
______________ _________________________________!
______________
______________
Other:____________________________
______________

_________________________________!
Student Preference Assessment

Activities (list favorite):


____________________________________
____________________________________
____________________________________
____________________________________!
Music (list songs/artists):

____________________________________
____________________________________
____________________________________
____________________________________!
Toys (list preferred toys):
_________________________________________
_________________________________________
_________________________________________
_________________________________________!

! the student does NOT like


Items
Drinks:________________________________________
____________________________________________!
Food:________________________________________________
___________________________________________________!
TV
Shows:_______________________________________________
____________________________________________________!
Movies:______________________________________________
____________________________________________________!
Other:_______________________________________________
____________________________________________________!
____________________________________________________!
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