TO BE COMPLETED BY THE TEACHER

Teachers: Please us your student intake forms plus your observations to complete one outcome report per student. Deadline for all reports: June 8, 2026.

Note- students who participated in both Fall and Spring should have the same student identifier for both Fall and Spring outcome reports for matching.
Your Contact Information
Please use the childs inititals and birth year, ex: BC2021 If two (or more) children would have the same initials/birth year, be sure to distinguish them by marking a, b, c, etc. ex: BC2021a and BC2021b would be two different children. Just be sure to use the same identifier for each child for both semester outcome reports so we can match them.
Student Age
Caregiver Relationship (Select all that apply)
Did this caregiver bring more than one child?
This child also participates in (Select all that apply)
How did the family hear about the program?

Teacher Observations of This Student

We do not expect children under 2 years old to demonstrate any of the skills below, so please use the "N/A- child is under 2" option where appropriate. However, if the under 2 year old child does demonstrate a skill, please feel free to mark Yes.

Pretends to write with pictures and scribbles.
Makes horizontal lines of writing scribble.
Includes letter-like forms in writing.
Makes some letters, prints name or initial.
Holds books right-side-up, turns pages left to right.
Pretends to read using pictures to tell a story.
Recalls stories from books with increasing accuracy.
Shows awareness that print in books tells a story.

Teacher Observations of the Caregiver of this Student

Please note any growth you observed in the caregivers this term. For example, "The grandmother shared that she reads more to her grandchild at home than she used to." or "The mother seems more confident in helping her child do the activities."