PRE-KINDERGARTEN SCREEN (PKS) SUMMARY FOR EARLY KINDERGARTEN ADMISSION
(Completed by the staff member administering the assessment)
Student ________________________________
Date Assessment Completed ___________________________
Directions to Staff Member completing assessment: Please provide a summary of scores for the assessment.
Testing Date ________Year_________Month________Day
Age at Testing________Year_________Month________Day * Do not round months up by one if days exceed 15.
Expected date of Kindergarten entry________Year_________Month________Day
Expected age at Kindergarten entry________Year_________Month________Day
SUBTEST SCORE /TOTAL POSSIBLE
A. Gross Motor _____/6
B. Fine Motor _____/10
C. Follow Directions _____/7
D. Block Tapping _____/4
E. Visual Matching _____/4
F. Visual Memory _____/7
G. Imitation _____/12
H. Academic Skill _____/ 42
I. Delay Gratification _____/ 3
PKS TOTAL RAW SCORE: ________/95 STANDARD SCORE: ___________ %ile *Percentile rank equal to or higher than 25 indicates child is eligible for entry to Kindergarten.
________ Student is eligible for enrollment in Kindergarten
________ Student in not eligible for enrollment in Kindergarten
Staff Member Signature _______________________________
Date__________________
