Information Processing Checklist
Student Name: ______
Grade: ______Current Date: ______ / Rater Name: ______Parent Teacher (Please Circle)
Setting Considered: Home School Other (Please Circle)

Please rate your student’s performance on the following items:

Completing mental math (W) / Adequate / Inadequate / Not Observed
Retelling events in a sequence (W, O, Pl) / Adequate / Inadequate / Not Observed
Following multi-step directions (W) / Adequate / Inadequate / Not Observed
Summarizing or paraphrasing (W) / Adequate / Inadequate / Not Observed
Clarity and organization of verbal answers (E) / Adequate / Inadequate / Not Observed
Use of body language in communication (E) / Adequate / Inadequate / Not Observed
Asking questions (E) / Adequate / Inadequate / Not Observed
Handwriting skills (E) / Adequate / Inadequate / Not Observed
Copying from the board (T) / Adequate / Inadequate / Not Observed
Using a separate answer sheet on tests/assignments (T) / Adequate / Inadequate / Not Observed
Organization skills (O) / Adequate / Inadequate / Not Observed
Managing time (O, Pl) / Adequate / Inadequate / Not Observed
Breaking large assignments into smaller tasks (Pl) / Adequate / Inadequate / Not Observed
Following classroom/lunchroom procedures (Pl) / Adequate / Inadequate / Not Observed
Timed tests (S) / Adequate / Inadequate / Not Observed
Completing work within expected time frame (S) / Adequate / Inadequate / Not Observed
Automaticity with basic skills (letter/number ID) (S) / Adequate / Inadequate / Not Observed
Spelling (Pr, Pl) / Adequate / Inadequate / Not Observed
Recognizing visual patterns (Pr) / Adequate / Inadequate / Not Observed
Phonemic Awareness (Pr) / Adequate / Inadequate / Not Observed
Understanding what s/he reads (A) / Adequate / Inadequate / Not Observed
Understanding what s/he sees (A) / Adequate / Inadequate / Not Observed
Understanding what s/he hears (A) / Adequate / Inadequate / Not Observed
Ability to learn a new game (A) / Adequate / Inadequate / Not Observed
Letter formation / writing legibly (M) / Adequate / Inadequate / Not Observed
Fine motor tasks (shoe tying, buttoning) (M) / Adequate / Inadequate / Not Observed

(W) Working Memory Including Verbal, Visual, or Spatial

(E) Verbal and Non-Verbal Expression

(T) Transfer of Information

(O) Organization

(P) Planning and Sequencing

(S) Speed of Processing

(P) Visual and Auditory Processing

(A) Acquisition of Information

(M) Motor Control for Written Tasks

Please Return to ______by ______. Thank You!