ANECDOTAL REPORT

School Year 20__ - 20__

I. GENERAL INFORMATION
Name: ______________________________________________________
Learner’s Reference No. ______________________________________________________
Birthdate ______________________________________________________
Age ______________________________________________________
Address ______________________________________________________
Grade ______________________________________________________
Name of Father ______________________________________________________
Name of Mother ______________________________________________________
Name of Guardian ______________________________________________________
Primary Dialect ______________________________________________________
Date of Evaluation ______________________________________________________
Entry Date Program ______________________________________________________
Projected Termination Date ______________________________________________________
Date of Referral ______________________________________________________

II. PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Area: COMMUNICATION

A. RECEPTIVE
1. Understands the use of
I
You
Me
Mine
Yours
Is
Are
Today
Yesterday
Tomorrow
Was
Will
Under
On
Inside
Outside

2. Answers the following questions correctly and spontaneously

2.1. What is your name?
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2.2. How old are you?

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2.3. How are you today?

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2.4. Who is your mother?

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 2.5. Who is your father?
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2.6. Who is your brother?

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2.7. Who is your sister?

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2.8. What is the weather today?

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2.9. Who are in school today?

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2.10. Who are not in school today?

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2.11. Why is __________ not in school today?

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2.12. What is the day today?

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2.13. What is the date today?

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2.14. What is the day yesterday?

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2.15. What will be the day tomorrow?

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2.16. Where is __________?

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2.17. Who is ready to go home?

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2.18. Are you ready to go home?

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2.19. Are you happy / mad?

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2.20. Why are you happy / mad?

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3. Follow 2 – step instructions

3.1. Wait and be quiet
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3.2. Sit down and read books

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3.3. Stand in line and wait

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3.4. Get your shoes and put them on

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B. EXPRESSIVE
1. Uses the following words / phrases / sentences correct and spontaneously.
1.1. I don’t like.
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1.2. I don’t know.

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1.3. Yes, please.

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1.4. Thank you.

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1.5. You’re welcome.

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1.6. I’m sorry.

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1.7. It’s alright.

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1.8. I like to borrow this book, please.

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1.9. I like to return this book, please.

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1.10.Goodbye.
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1.11.See you tomorrow / Monday.

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1.12.No, thank you.

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1.13.Please, give / share.

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2. Able to identify the activity they are doing.

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3. Able to identify or recall the activities done for the day.

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4. Able to say or write facts pertaining situation (e.g. Today is Monday. Brenna is
not here.)
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Area: SOCIAL BEHAVIOR

1. Waits for turn.
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2. Stands in line.
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3. Initiate greetings.
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4. Responds to greeting spontaneously.

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5. Stops activity and look when called.

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6. Borrows toys, books, etc. from classmate.

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7. Asks for food, drink, help, etc.

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8. Identifies own belongings.

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9. Sits down with classmates during

a. Free play
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b. Group time
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c. Waiting period
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d. Group reading / story telling

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e. Worksheet time
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10. Initiates the leading of prayers and songs.

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Area: PRE-ACADEMICS AND ACADEMICS

1. Focuses on the instructions and activities.
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2. Visual tracks from left to right and up and down directions.

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3. Names all the letters both upper and lower case.

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4. Sounds off letter correctly.

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5. Reads consonant blends.

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6. Reads consonant – vowel blends.

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7. Reads CVC’s.
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8. Reads high frequency words.

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 9. Syllabicates words.
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10. Spell words.

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11. Sequences letters A – Z.

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12. Counts objects correctly (1-30).

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13. Identifies and sequence numbers (1-30).

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14. Rote counts 1 – 50.

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15. Does simple to complex patterns.

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16. Sort objects according to group or categories.

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17. Reads phrases, sentences and stories.

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18. Comprehends what he reads.

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19. Identifies favorite part of the story.

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Area: FINE MOTOR DEVELOPMENT

1. Pre – writing skills
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2. Writing skills
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3. Pre – vocational skills

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Area: SELF-HELP AND INDEPENDENT LIVING SKILLS

1. Packs away belongings and other objects properly.
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2. Carries belongings and other objects properly.

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3. Takes off and put on socks.

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4. Takes off and put shoes.

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5. Brushes teeth properly.

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 6. Takes off and puts on socks.
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7. Sets table.
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8. Wipes table and placemats.

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9. Washes dishes.
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10. Prepare simple snacks.

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11. Uses utensils properly.

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12. Tastes or eat food during the food program.

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13. Throws trash properly.

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Area: BEHAVIOR
1. General Compliance
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2. Adaptation
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3. Sensory interrogation
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Area: STUDENT’S PERFORMANCE

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Area: PULL-OUT MAINSTREAMING

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