60 Month Questionnaire

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Child's Information

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Program Information

On the following pages are questions about activities children may do. Your child may have already done some of the activities described here, and there may be some your child has not begun doing yet. For each item, please fill in the circle that indicates whether your child is doing the activity regularly sometimes, or not yet.

Important Points to Remember:

  • Try each activity with your child before marking a response.
  • Make completing this questionnaire a game that is fun for you and your child.
  • Make sure your child is rested and fed.

Communication

Here are the example texts:

  • Jane hides her shoes for Maria to find.
  • Al read the blue book under his bed.

Gross Motor

Fine Motor

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      Problem Solving

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      Personal-Social

      Overall

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