Mcps Form 335 37 PDF Details

In the landscape of educational and developmental support for young children, the MCPS 335 37 form plays a pivotal role. This crucial document, titled "Pre-kindergarten/Head Start Speech-Language Screening Instrument," emanates from Montgomery County Public Schools' Division of Early Childhood Programs and Services in Rockville, Maryland. Intended for use by a qualified speech/language pathologist, this form facilitates the early identification of speech and language challenges in pre-kindergarten and Head Start students. Through a series of checks and balances, the form assesses a broad range of language skills including the child's ability to communicate general information about themselves, their understanding of number concepts, color identification, prepositions, body parts, senses, categories, ability to answer questions, listening comprehension, and more. Additionally, it evaluates auditory memory, expressive language, syntax, the ability to follow directions, articulation, fluency, voice, and even hearing capabilities. Scores and observations recorded on the MCPS 335 37 form serve as a foundational step in devising appropriate interventions or further assessments, ensuring that each child receives the support necessary to thrive in their educational journey.

QuestionAnswer
Form NameMcps Form 335 37
Form Length2 pages
Fillable?Yes
Fillable fields148
Avg. time to fill out30 min 6 sec
Other names335 37 mcps pre kindergartenhead start articulation screening form

Form Preview Example

Pre-kindergarten/Head Start Speech-Language Screening Instrument

Division of Early Childhood Programs and Services

 

MONTGOMERY COUNTY PUBLIC SCHOOLS • Rockville, Maryland 20852

Page 1 of 2

INSTRUCTIONS: This screening test is to be administered by a speech/language pathologist. For each response, place a check ( ) in column “C” (Correct) or column “I” (Incorrect) as appropriate. Space is provided for child’s response. Write “NR” for no response.

Student’s name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current school

 

 

 

 

Birth date

 

 

/

 

 

/

 

 

Age

 

 

 

Test Date

 

 

/

 

 

 

/

 

 

 

 

 

 

 

 

Home school

 

 

 

 

Primary language

 

 

 

 

 

 

 

Teacher

 

 

 

 

 

 

 

 

 

 

Speech pathologist

 

 

 

PART I: LANGUAGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check One

A. GENERAL INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Correct/Incorrect

1.

Tells first and last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Tells age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

B. NUMBER CONCEPTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Rote counts to 10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Counts blocks to 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. COLORS (Display 6 colored blocks; point to each and ask:) “What color is this block?” (Circle correct responses.)

 

 

 

5.

Blue

Yellow

 

 

Purple Green

 

Red Orange

(Passing criteria: 3 correct)

 

 

 

 

 

 

 

(If not correct, ask child to point to colored blocks.)

 

 

 

 

/

 

 

 

 

correct

5.

 

 

 

 

 

 

 

 

 

 

D. PREPOSITIONS (Demonstrate with block and box and ask:) “Where is the block?”

 

 

 

6.

In

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Under

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

On

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

9.

Behind/In back of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If incorrect, ask child to place block in that position.)

 

 

 

/

 

 

 

correct

 

 

 

 

 

 

 

(Check correct responses: In Under On Behind )

9.

 

E.IDENTIFIES BODY PARTS (Ask child to point to body parts. Check those identified correctly.) (Passing criteria: 6 or more correct)

 

Nose Eyes Ears Mouth Hair

 

 

 

 

 

 

 

 

 

Finger Knee Elbow Arm Foot

Total Correct

 

 

/10

 

10.

 

 

 

F. COMPREHENDS SENSES (Read practice sentence to child.) “We use our hands to (touch/feel.)”

11.

11.

“We use our eyes to

 

 

.“ (see/look)

 

 

 

 

12.

12.

“We use our nose to

 

 

.“ (smell/breathe)

 

 

 

 

13.

“We use our ears to

 

 

.” (hear/listen)

 

 

 

 

13.

G. CATEGORIES (Use picture provided and say:)

 

 

 

 

 

 

 

 

 

14.

“Show me all the animals.”

 

 

 

 

 

 

 

14.

 

 

 

 

 

 

 

15.

“Show me all the food.”

 

 

 

 

 

 

 

15.

H. ANSWERING QUESTIONS (Ask sample question.) “Who cries?” (Explain as necessary.)

 

 

 

16.

What flies in the sky?

 

 

 

 

 

 

16.

17.

What animal swims in the water?

 

 

 

 

 

 

17.

18.

What animal bites people?

 

 

 

 

 

 

18.

19.

What do you do when you are hungry?

 

 

 

 

 

 

19.

20.

What do you wear when it’s cold outside?

 

 

 

 

 

 

20.

 

 

 

 

 

 

21.

What do you do when you’re sleepy?

 

 

 

 

 

 

21.

I.LISTENING COMPREHENSION (Directions: “I’m going to tell you a story. It has no pictures. Listen carefully. When I’m finished, I will ask you some questions about the story.”) (Read:) “One day, a man was painting a house. He was standing on a ladder. A bee buzzed around his head. The man climbed down and waited until the bee flew away.”

22.

Who was painting the house?

 

22.

 

23.

Where was he standing?

 

23.

 

24.

Why did he climb down?

 

24.

 

 

 

MCPS Form 335-37, Rev. 8/05

DISTRIBUTION: ORIGINAL/Cumulative Folder; COPY 1/Pre-Kindergarten/Head Start Unit;

 

 

COPY 2/Speech-language pathologist

 

 

Student’s name

 

Signature, Speech-language pathologist

PART I: LANGUAGE (continued)

Check One

 

Correct/Incorrect

J.AUDITORY MEMORY FOR SENTENCES (Example—say: “Black cat”)

25.

“Toy...Chair...Light”

 

25.

 

26.

“Cars are big.”

 

26.

 

27.

“He sleeps in a bed.”

 

27.

 

28.

“The boy played ball with his dog.”

 

28.

 

K.EXPRESSIVE LANGUAGE SAMPLE (Use sequence picture provided. Point to each picture and say: “Tell me a story about these pictures.” Record responses on lines provided, including articulation errors. Give credit if the child uses a minimum of three phrases or sentences that include action words.)

29.

 

29.

 

 

 

 

L. SYNTAX (Record any grammatical differences or errors on lines provided.)

 

 

 

 

 

 

 

 

 

 

M. FOLLOWING DIRECTIONS (Say: “Listen carefully. I want you to do three things.”)

 

 

 

30. “Clap your hands. Put your hands on your head. Touch your nose.”

30.

 

(Passing criteria: Child performs all 3 directions.)

 

 

 

If incorrect, say: “Close your eyes. Clap your hands.”

 

 

 

TOTAL

Correct/Incorrect

PART II: SPEECH

A. ARTICULATION (Record sound errors.)

Spontaneous speech: Intelligible Not intelligible Intelligible with careful listening Not enough said to judge

If multiple errors, administer Pre-kindergarten/Head Start Articulation Screening and check oral motor functioning.

Adequate Recheck

B. FLUENCY: Fluent Dysfluent Comments

C. VOICE: Adequate If not adequate, describe quality.

PART III: HEARING

No known problem Suspect problem

History of Problem

PART IV: FOLLOW-UP AND COMMENTS

 

1.

Speech and language is within normal limits.

3.

English Language Learner (ELL)

COMMENTS

2.Confer with team/observe further.

4.Administered in (language)

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entering details in Mcps Form 335 37 part 1

Please prepare the Total, Correct We, use, our, eyes, to We, use, our, nose, to We, use, our, ears, to see, look smell, breathe hear, listen G, CATEGORIES, Use, picture, provided, and, say Show, me, all, the, animals Show, me, all, the, food What, ies, in, the, sky What, animal, swims, in, the, water What, animal, bites, people What, do, you, do, when, you, are, hungry and What, do, you, wear, when, its, cold, outside space with the essential data.

Filling out Mcps Form 335 37 part 2

Point out the considerable data the Students, name Signature, Speech, language, pathologist PARTI, LANGUAGE, continued Toy, Chair, Light Cars, are, big He, sleeps, in, abed The, boy, played, ball, with, his, dog Check, One and Correct, Incorrect section.

Filling out Mcps Form 335 37 stage 3

Spell out the rights and responsibilities of the sides in the field PART, II, SPEECH A, ARTICULATION, Record, sound, errors TOTAL, Correct, Incorrect Adequate, Recheck B, FLUENCY, Fluent, Dys, u, ent, Comments C, VOICE, Adequate If, not, adequate, describe, quality PART, III, HEARING No, known, problem, Suspect, problem and History, of, Problem

stage 4 to completing Mcps Form 335 37

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Mcps Form 335 37 PARTIVFOLLOWUPANDCOMMENTS, and COMMENTS blanks to complete

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