BrainWare Cognitive Rating Scale (9-12) - Cognitive Literacy Solutions

Brain Ware Cognitive Rating Scale (Ages 9-12)

The purpose of this rating scale is to enable a parent or teacher to evaluate a child on behaviors that typically relate to cognitive development in key areas. Please read each of the statements and rate the child according to the following scale. After you have rated the child on all statements, we will calculate a score for this child in each area. After you complete the form and click “SUBMIT,” you will get an email with a summary of your ratings and results by cognitive area.

Person Performing the Evaluation
Name*
First Name Last Name
Email*
Relationship with child*
Person Being Evaluated
Name*
First Name Last Name
Age*
Please enter a number from 9 to 12.
Gender*
Date of Evaluation*
MM slash DD slash YYYY

Attention Skills*

	Significantly Below Average	Below Average	Average	Above Average	Significantly Above Average
1. Can sustain attention for approriate periods of time in routine home and school situations
2. Can maintain proper attention even when distractions are present
3. Pays attention to details
4. Listens carefully and maintains eye contact when being spoken to
5. Is organized (schoolwork, bedroom, etc.)
6. Can shift attention smoothly when moving from one activity to another

Memory Skills*

	Significantly Below Average	Below Average	Average	Above Average	Significantly Above Average
7. Can remember his or her address and phone number, dates, names and other basic facts
8. Can remember information learned for tests
9. Remembers to do things he or she was asked to do
10. Once he or she learns to do a task, remembers how to do it days or weeks later
11. Can remember the details of a story he or she just read
12. Can remember the details of instructions given and carries out the instructions correctly

Perceptual Processing*

	Significantly Below Average	Below Average	Average	Above Average	Significantly Above Average
13. Can follow a map
14. Does not make a lot of careless errors
15. Can work on schoolwork independently without much help
16. Understands and does not get confused when instuctions are given
17. Can handle complex tasks requiring significant mental effort, without getting frustrated
18. Completes homework or other tasks that require mental effort in the appropriate amount of time

Thinking Skills*

	Significantly Below Average	Below Average	Average	Above Average	Significantly Above Average
19. Learns from mistakes
20. Plans ahead and uses forethought
21. Uses good judgment
22. Is good at finding solutions to problems
23. Can predict the outcome of situations or stories
24. Uses imagination and creativity

Life Management Skills*

	Significantly Below Average	Below Average	Average	Above Average	Significantly Above Average
25. Manages time effectively
26. Does not procrastinate
27. Completes assignments and tasks on time
28. Establishes proper priorities
29. Is able to see things from multiple perspectives
30. Plans how to accomplish short- and long-term goals

Self Esteem*

	Significantly Below Average	Below Average	Average	Above Average	Significantly Above Average
31. Has confidence in his or her learning ability
32. Enjoys taking on challenging tasks
33. He or she feels well-liked
34. Bounces back from failures or setbacks quickly
35. Does not need a lot of reassurance in most areas of life
36. Exhibits good motivation and effort towards learning and school

BrainWare Cognitive Rating Scale (Ages 9-12)

Brain Ware Cognitive Rating Scale (Ages 9-12)

Person Performing the Evaluation

Person Being Evaluated

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BrainWare Cognitive Rating Scale (Ages 9-12)

Brain Ware Cognitive Rating Scale (Ages 9-12)

Person Performing the Evaluation

Person Being Evaluated

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