Work Sampling System® — Assessment Tool

The Work Sampling System® Developmental Checklist

4th Edition · Prodigy Preparatory Education Center

Rating Key:

Not Yet — child cannot demonstrate indicator

In Process — child demonstrates indicator intermittently

Proficient — child can reliably demonstrate indicator

F = Fall W = Winter S = Spring

Child:

Date of Birth:

Teacher:

School:

Sex: Female Male

Observation Periods:

Fall

Winter

Spring

Printed Name

Signature (type full name to confirm)

Date

Parent / Guardian Printed Name

Signature (type full name to confirm)

Date

Relationship to Child

Phone / Email

ⓘ By signing, parent/guardian confirms they have reviewed this developmental checklist with the teacher and had the opportunity to ask questions.

Director's Email:

Your Email (CC):

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