Spaces for Active Learning (SAL) Data Form

Child:______Date:______Time Started in SAL:______

Time Ended in SAL:______

*Each box corresponds to a hole in the top of the Plexiglas. Write the name of object on line provided.

______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other:
______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other:
______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other:
______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other:

Describe environmental conditions: ______

Check behavior that applies:

___ typical amount of activity___ typical amount of boundary exploration

___ less than typical___ less than typical

___ more than typical___ more than typical

___ typical amount of vocalization___ typical amount of body movements

___ less than typical___ less than typical

___ more than typical___ more than typical

Spaces for Active Learning (SAL) Data Form: SAMPLE

Child: SarahDate: 5/9/09 Time Started in SAL: 9:15 AM

Time Ended in SAL: 9:45 AM

*Each box corresponds to a hole in the top of the Plexiglas. Write the name of object on line provided.

Yellow pom pom
Looked:
Batted:
Grasped: l l l
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other:
______
Looked:
Batted:
Grasped:
Other: / Small Jingle bells on ribbon
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other:
Plastic cup
Looked:
Batted: l l
Grasped:
Other: / Wooden spoon w/slots
Looked:
Batted: l l l
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / Plastic beads
Looked:
Batted: l
Grasped: l l l
Other:
Toothbrush
Looked:
Batted: l l l
Grasped: l l l
Other: / ______
Looked:
Batted:
Grasped:
Other: / ______
Looked:
Batted:
Grasped:
Other: / Cloth fringe length
Looked:
Batted:
Grasped:
Other:

Describe environmental conditions: classroom was quiet with other students gone.

Check behavior that applies:

X typical amount of activity___ typical amount of boundary exploration

___ less than typical X less than typical

___ more than typical___ more than typical

X typical amount of vocalization___ typical amount of body movements

___ less than typical X less than typical

___ more than typical___ more than typical