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* 1. Your Name

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* 2. Your Child's Name and Date of Birth

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* 3. Your Phone Number and e-mail address

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* 4. Does your child follow 2-3 step directions in sequence?

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* 5. Does your child follow, participate in, and start simple conversations?

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* 6. Does you child answer open-ended questions (“What did you
have for lunch today?”)

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* 7. Does your child say all sounds expected in speech except: r,  z, th

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* 8. Does your child compare and match words based on sounds, & identify words that rhyme?

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* 9. Does your child retell a story or talk about an event?

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* 10. Does your child know at least 30 sight words?

T