Preparatory

Part – A (1)

PART A (1)

GENERAL INFORMATION

Student Name:

Roll No.:
Reg No.:

Class: 3 4 5

Section:
DOB:

Address:

Phone:

Number of siblings:

Siblings’ age:

Mother/Guardian Name:

Education:

Occupation:

Father/Guardian Name:

Education:

Occupation:

Mother Tongue:

Medium of Instruction:

Rural/Urban:

Photograph

ATTENDANCE

MONTHS APR MAY JUNE JUL AUG SEP OCT NOV DEC JAN FEB MAR
No. of Working Days
No. of Days Attended
% of Attendance
If attendance is low, reasons thereof

Part – A (2)

PART A (2)

My name is:

I am years old.

My Family

Paste a picture or draw

Some of my favorite things…

Food:

Games:

Festivals:

When I grow up I want to be…

My Idol

One person who inspires me is:

Three things I want to learn this school year:

Part – A (3)

PART A (3)

How do I feel at school?

Circle the most appropriate option for each sentence.

Statement Response

Peer Feedback

Peer Feedback

Peer 1

Circle the most appropriate option for each sentence.

My name:
My friend’s name:
Statement Response

Your Child Matters

Your Child Matters!

Tick the resources available to your child at home.

How can I know your child better?

Circle the most appropriate option for each statement.

Statement Response

Your Child Matters!

Tick the resources available to your child at home.

How can I know your child better?

Circle the most appropriate option for each statement.

Statement Response

My child needs support with…

Part B

Learning Standard Selection

Curricular Goals
(Can choose one or more)
Competencies
(Can choose one or more)
Activity
Assessment Questions

ASSESSMENT RUBRIC*

Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

Techer’s Feedback

Teacher’s Feedback

Abilities Key Performance Level Descriptors
Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

*Please put a tick mark (✔) to indicate the performance level of each ability.

Observational Notes

Think about how the learner performed…

What challenges did the learner face? How did they overcome them? / How did you help them?

Self Assessment

Self-Assessment

Please answer the following regarding the activity you just completed.

Colour the emoji for each statement.

Statement Response
I followed my teacher’s instructions. 😊 yes 😐 no ❓ not sure
I liked doing this work. 😊 yes 😐 no ❓ not sure
I asked for help if I didn’t understand. 😊 yes 😐 no ❓ not sure
I tried my best in this task. 😊 yes 😐 no ❓ not sure
I am proud of my work. 😊 yes 😐 no ❓ not sure
I want to do this task again. 😊 yes 😐 no ❓ not sure
I liked working with my classmates. 😊 yes 😐 no ❓ not sure
I could ask my classmates for help, and they helped me. 😊 yes 😐 no ❓ not sure

Part C

SUMMARY FOR THE ACADEMIC YEAR

Tick the appropriate performance level descriptor and write an observational note for each category based on performance throughout the academic year.

Language (R1)

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

Language (R2)

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

Mathematics

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

SUMMARY FOR THE ACADEMIC YEAR

Tick the appropriate performance level descriptor and write an observational note for each category based on performance throughout the academic year.

The World Around Us

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

Art Education

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

Physical Education

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity

SUMMARY FOR THE ACADEMIC YEAR

Tick the appropriate performance level descriptor and write an observational note for each category based on performance throughout the academic year.

Overall

50
Abilities Beginner Proficient Advanced
Awareness
Sensitivity
Creativity