This interactive form will create standard "feedback" letters for the cognitive testing portion of a CKiD participant visit. First time users should review the Psychologist Corner Instructions for more detailed directions on completing this interactive form and generating the feedback letters.

Date of Evaluation:
mm/dd/yy
     
Select all administered tests: Enter scale scores (and grade equivalent where needed):  
     
   

Scale scores:

Age Equivalent

or

Percentile Scores:

  
Mullen Gross motor:   Gross motor < 35:
  Fine-motor:   Fine-motor < 35:
  Visual reception:   Visual reception < 35:
  Expressive language:   Expressive language < 35:
  Receptive language:   Receptive language < 35:
  Early learning composite:   Early learning composite < 78:
           
WPPSI-III, version 2:6-3:11 Information:  

Information < 6:
  Receptive vocabulary:  

Receptive vocabulary < 6:
  Verbal IQ:

Verbal IQ < 78:
  Block design:  

Block design < 6:
  Object assembly:  

Object assembly < 6:
  Performance IQ:

Performance IQ < 78:
  Full-scale IQ:

Full-scale IQ < 78:
           
WPPSI-III, version 4:0-7:3 Information:  

Information < 6:
  Vocabulary:  

Vocabulary < 6:
 

Word reasoning:

  

Word reasoning < 6:
 

Verbal IQ:

Verbal IQ < 78:
 

Block design:

  

Block design < 6:
 

Matrix reasoning:

  

Matrix reasoning < 6:
 

Picture concepts:

  

Picture concepts < 6:
 

Coding:

  

Coding < 6:
 

Performance IQ:

Performance IQ < 78:
 

Full-scale IQ:

Full-scale IQ < 78:
           
WASI

Vocabulary:

  

Vocabulary < 35:
 

Similarities:

  

Similarities < 35:
 

Verbal IQ:

Verbal IQ < 78:
 

Block design:

  

Block design < 35:
 

Matrix reasoning:

  

Matrix reasoning < 35:
 

Performance IQ:

Performance IQ < 78:
 

Full-scale IQ:

Full-scale IQ < 78:
           
WIAT-II-A

Word reading:

Word reading < 78:
 

Numeric operations:

Numeric operations < 78:
 

Spelling:

Spelling < 78:
 

Overall score:

Total score < 78:
           
K-CPT

Omissions

  

Omissions > 65:
 

Commissions

  

Commissions > 65:
           
CPT-II

Omissions

  

Omissions > 65:
 

Commissions

  

Commissions > 65:
           
Please write any comments that you would like appended to the letter: