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My Teacher Wants to Know

Child's Name
Date
 
How is my mood : Not So Well                  Very Well
in the morning   1   2 3 4 5
 
in the afternoon   1   2 3 4 5
 
in the evening   1   2 3 4 5
 
sleep   1   2 3 4 5
 
nap   1   2 3 4 5
 
eat lunch   1   2 3 4 5
 
eat dinner   1   2 3 4 5
 
play with adults   1   2 3 4 5
 
play by myself   1   2 3 4 5
 
play with another child   1   2 3 4 5
 
play in a small group   1   2 3 4 5
 
play in a large group   1   2 3 4 5
 
play inside   1   2 3 4 5
 
play outside   1   2 3 4 5
 
play with younger children   1   2 3 4 5
 
play with older children   1   2 3 4 5
 
play with children near me   1   2 3 4 5
 
do what the teacher asks of me   1   2 3 4 5
How do I let people know
 
I am angry or upset
I am happy
I want something
I don't want something
I like something
I don't like something
What helps me when I am
What makes me angry/upset
What makes me happy/excited
Parent Name:
Email
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