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: LC

Date: 10/18/2016

Age: 4
Grade: PPCD
Gender: Male
Instruments Administered:
The assessment that was given is a modified version of the CLI engaged. The student was not
administered all pieces of the assessment.
Instruments that were administered included
Identifying shapes
Upper and lower case letters
Numbers 0-10
Rapid Vocabulary (modified) Student would be shown too pictures and asked to find an object.
Example: Teacher holds up ball and apple. Teacher says Give me apple, student will either point
or grab the correct picture.
All parts of test were given using physical objects, rather than completing on the computer.
Recommended Objectives:
(Example: TLW identify the main idea in 3 out of 4 passages with an accuracy rate of 75%.)
Using objects or picture card, LC will be able to receptively or expressively identify at least 15 items when
shown an array of two or more objects or picture cards, with no more than one prompts with 70%
accuracy.
Using objects LC will be able to identify 2-4 shapes with no more than 2 prompts with 70% accuracy.
LC will rote count up to three and use one to one correspondence to count up to three objects with no
more than two prompts with 70% accuracy.
Using manipulatives, LC will be able to identify 2-4 letters and match to their corresponding lower case
letter with no more than 2 prompts with 70% accuracy.
Describe 5 activities to be implemented in class based on the findings of the assessment and your
cooperating teachers 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 match upper case letters to the corresponding upper case letter. Example
student is shown letters H,C,L. Student will be given letter C and told match letter C.
- Rationale: Having the student match letters will allow the student to see the letters and hear the
letter name. It allows the student an opportunity to start recognizing the name of the letter and the
letter itself together.
2. The student will be shown a number and then point and count objects as the teacher counts aloud.

-Rationale: This is already a goal for the student. More practice is needed in this area. By showing
the student the actual number, and then counting the objects, the student can actually see what that
number physically looks like.
3. The student will match physical objects to their picture cards.
Rationale: The student has trouble correlating physical objects to their 2d version. He may be
able to recognize a chair physically, but when he sees a picture of a pencil he has trouble identifying it. By
matching the physical object to its picture card, he can see that it is the same object even though it is just
a picture of the object.
4. The student will identify shapes using real life objects.
Rationale: The student is able to identify some shapes just as a picture. However, he has trouble
recognizing real life objects as shapes. It is important for the student to be able to recognize different
objects as shapes. Each week, the student will be introduced to a new shape. The student can then go
around the classroom and find different objects that are the same shape.
5. The student will match upper case letters to the corresponding lower case letter.
Rationale: The student struggled with all of his lower case letters. He was not consistent when the
letters were moved around.

Comments:
This is the first time the CLI engage was given to the PPCD students. This was also the first time my
cooperating teacher had given the assessment. This was a learning experience for both me and my
teacher. I found this test somewhat difficult to give because we had to modify, so many parts of it. It was
also difficult to tell if the student really knew the answer, or if he just pointed to whatever he saw first.
However, it did help us see what the student was consistent on and what areas he was inconsistent. This
test also took a while to give. These students cannot focus on a task for long, so it required many breaks.
Overall, I think the assessment is appropriate for this age group. However, it does take a long time to fully
give the assessment and make sure the results are accurate.