SPED 603 METHODS AND MATERIALS FOR

TEACHING EXCEPTIONAL CHILDREN

INFORMAL ASSESSMENT

I. INFORMATION
A. Child’s Information
Name: __________________________________ Sex: ______________ Age: ________________
Birthdate: _________________________ Birthplace: ____________________________________

B. CHILD’S HISTORY
Pre- Natal

Post Natal

C. FAMILY BACKGROUND
Name of Father: ____________________________ Age: _________ Occupation: __________________
Name of Mother: ___________________________ Age: _________ Occupation: __________________
Child’s Birth Rank: ________________ No. of Brothers: _______ No. of Sisters: _________
Do you have siblings/ any members of the family with disability? Yes _________ No _________
If yes, please specify ____________________________

II. SCREENING
A. Observed Behavior
 B. Findings

III. DIAGNOSIS
A. Observed Behavior

B. Findings

C. Recommendations

Prepared by:
____________________________