Adaptive PE Participation Assessment

Adaptive PE Participation Assessment — Form Fields

This education template includes 12 fields. Assessment form for determining adapted physical education needs for students with disabilities. Free to customize and use on ZenBuild.

• Student Name (text, required)
• Date of Birth (text, required)
• Grade Level (text, required)
• School Name (text, required)
• Evaluator Name (text, required)
• Evaluator Role (dropdown selection, required) — options: PE Teacher, Adapted PE Specialist, Occupational Therapist, Physical Therapist, Special Ed Teacher
• Primary Disability (dropdown selection, required) — options: Orthopedic Impairment, Visual Impairment, Hearing Impairment, Autism, Intellectual Disability, Emotional Disturbance, Other Health Impairment, Multiple Disabilities
• Areas of Concern (checkboxes, required) — options: Gross Motor, Fine Motor, Balance, Coordination, Endurance, Flexibility, Spatial Awareness, Social Interaction
• Current Physical Fitness Level (rating, required)
• Uses Assistive Device (multiple choice, required) — options: Yes, No
• Recommended Modifications (long text, required)
• Goals for Adapted PE Program (long text, required)