item(s) need revision. (For missing evaluations, you may be able to save this form as is, by first checking the incomplete box.)



Desired Results Developmental Profile access
Rating Record

 
  
  Incomplete
 
Child's information
 
1. Student ID (Issued by district for reporting to CASEMIS)
2. Statewide Student Identifier
(10-digit SSID)
3. First Name (Legal)
4. Last Name (Legal)
5. Gender
6. Birth date
 

 
Child's language information
(NOTE: As of October, 2012, the language information is no longer required, and does not appear on the printed information form)
 
Is this child an English Learner? Yes No
 
If Yes, what is/are the child's home language(s)? If Yes, what is/are the child's home language(s)?
(select/specify up to three)
1. 
 
2. 
 
3. 
 
Other languages / legacy entries (used only if nothing appears above) 
 
Was the child assessed by someone knowledgeable of his/her home language?
 

 
Child's ethnicity/race information
 
7a. Is this child Hispanic or Latino?
(select one)
 
7b. What is the race of this child? 7b. What is the race of this child?
(the DRDP report can use up to the first three specified)
 
1. 1.   -
 
2. 2.   -
 
3. 3.   -
 
4. 4.   -
 
5. 5.   -
 
6. 6.   -
 
 

 
Child's disability information
 
8. Primary Disability. 8. Primary Disability. -
 

 
Child's adaptation information
 
9. Adaptations
(Note: These selections affect all DRDP rating records for this student.) Check all that apply.
 
Augmentative or alternate communication system
Alternative mode for written language
Visual support
Assistive equipment or device
Functional positioning
Sensory support
Alternative response mode
 

 
Program information
 
10. SELPA
 
11. District of service
 
12. Name of person completing the assessment 12. Name of person completing the assessment
 
13. Role of person completing the assessment 13. Role of person completing the assessment  (specify if other:) 
 

 
Assessment information
 
14. Special Education Enrollment 14. Special Education Enrollment
 
15. Date DRDP access was completed 15. Date DRDP access was completed
 

 
Note: The Rating Record is not meant to be used independent of the DRDP access Manual or Booklet. You will need to refer to the DRDP access Manual or Booklet to complete this Rating Record. This record plus an Information Page must be completed for all children birth to five who receive special education services from LEAs.

Instructions: Write the child’s name, student identification number (issued by the district for reporting to CASEMIS), and the date this Rating Record was completed. Record the numerical rating for each Measure ­ the number that corresponds to the Descriptor for the highest developmental level the child has mastered. Check EM (emerging) if the child is “emerging” to the next level (optional). In the rare circumstance that you are unable to rate a particular Measure, check UR (unable to rate) and circle the reason why you are unable to rate this Measure (absence or other).
 

 
Measure Description Rating EM UR UR Reason
1. SELF1 1. SELF1 Identity of Self
2. SELF2 2. SELF2 Recognition of Own Skills and Accomplishments
3. SELF3 3. SELF3 Self-Expression

Measure Description Rating EM UR UR Reason
4. SOC1 4. SOC1 Expressions of Empathy
5. SOC2 5. SOC2 Interactions with Adults
6. SOC3 6. SOC3 Relationships with Familiar Adults
7. SOC4 7. SOC4 Developing Friendships
8. SOC5 8. SOC5 Building Cooperative Play with Other Children
9. SOC6 9. SOC6 Conflict Negotiation
10. SOC7 10. SOC7 Awareness of Diversity

Measure Description Rating EM UR UR Reason
11. REG1 11. REG1 Impulse Control
12. REG2 12. REG2 Seeking Other’s Help to Regulate Self
13. REG3 13. REG3 Responsiveness to Other’s Support
14. REG4 14. REG4 Self-Comforting
15. REG5 15. REG5 Taking Turns

Measure Description Rating EM UR UR Reason
16. LANG1 16. LANG1 Language Comprehension
17. LANG2 17. LANG2 Responsiveness to Language
18. LANG3 18. LANG3 Expresses Self Through Language
19. LANG4 19. LANG4 Uses Language in Conversation

Measure Description Rating EM UR UR Reason
20. LRN1 20. LRN1 Curiosity and Initiative
21. LRN2 21. LRN2 Attention Maintenance and Persistence

Measure Description Rating EM UR UR Reason
22. COG1 22. COG1 Memory
23. COG2 23. COG2 Cause and Effect
24. COG3 24. COG3 Engages in Problem-Solving
25. COG4 25. COG4 Object and Pretend Play

Measure Description Rating EM UR UR Reason
26. MATH1 26. MATH1 Number Sense: Understands Quantity and Counting
27. MATH2 27. MATH2 Number Sense: Math Operations
28. MATH3 28. MATH3 Number Sense: Comparison of Quantity
29. MATH4 29. MATH4 Shapes
30. MATH5 30. MATH5 Time
31. MATH6 31. MATH6 Classification and Matching
32. MATH7 32. MATH7 Measurement
33. MATH8 33. MATH8 Patterning

Measure Description Rating EM UR UR Reason
34. LIT1 34. LIT1 Interest in Literacy
35. LIT2 35. LIT2 Concepts of Print
36. LIT3 36. LIT3 Letter and Word Knowledge
37. LIT4 37. LIT4 Phonological Awareness
38. LIT5 38. LIT5 Emerging Writing
39. LIT6 39. LIT6 Comprehension of Text

Measure Description Rating EM UR UR Reason
40. MOT1 40. MOT1 Movement
41. MOT2 41. MOT2 Balance
42. MOT3 42. MOT3 Grasp/Release and Manipulation
43. MOT4 43. MOT4 Eye-Hand Coordination

Measure Description Rating EM UR UR Reason
44. SH1 44. SH1 Personal Care Routines: Toileting and Hygiene
45. SH2 45. SH2 Personal Care Routines: Dressing
46. SH3 46. SH3 Personal Care Routines: Self-Feeding
47. SH4 47. SH4 Personal Safety
48. SH5 48. SH5 Understanding Healthy Lifestyle: Eating and Nutrition
 

 
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