Set Combining Assessment Worksheet
IEP Assessment Form A • Probe 1
IEP Target: Combining Sets (80% Mastery / 4 of 5 Correct)
Set Combining Assessment
Trial #: 1 2 3 4 5
Student:
Date:
Score:
____ / 5
Directions: 1. Count the objects in each set. 2. Write each number in the box. 3. Combine the sets to find the total sum!
1 Teddy Bear Counters
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2 Linking Cubes
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3
Star Tokens 3 Sets (Combine All)
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4 Two-Color Chips
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5 Pattern Shapes
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Trial 1 Score: ____ / 5 ( ____ % )
80% Criterion Met: YES (≥4/5) NO (<4/5)
Support Level: [ ] Independent [ ] Visual/Gestural Prompt [ ] Verbal Guidance [ ] Concrete Touch/Move
Evaluator: ___________________
IEP Assessment Form B • Alternate Probe
Progress Monitoring • Trial Session 2 or Retest
Set Combining Assessment • Form B
Name: Date:
Count each manipulative set, write the numbers, and write the combined sum in the highlighted box.
1 Bear Counters
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2 Linking Cubes
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3
Stars 3 Sets
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4 Math Chips
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5 Hexagons & Triangles
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IEP Goal Master Record 5-Trial Progress Monitoring Data Log
Criterion: 80% (≥4/5) in 3 of 5 Trials
| Trial | Date | Tool / Form | Score | % Acc. | ≥80% Met? | Prompting Level & Evaluator Notes |
|---|
| Trial 1 | ___/___/___ | [ ] A [ ] B [ ] Real | ___ / 5 | ___ % | [ ] Y [ ] N | |
| Trial 2 | ___/___/___ | [ ] A [ ] B [ ] Real | ___ / 5 | ___ % | [ ] Y [ ] N | |
| Trial 3 | ___/___/___ | [ ] A [ ] B [ ] Real | ___ / 5 | ___ % | [ ] Y [ ] N | |
| Trial 4 | ___/___/___ | [ ] A [ ] B [ ] Real | ___ / 5 | ___ % | [ ] Y [ ] N | |
| Trial 5 | ___/___/___ | [ ] A [ ] B [ ] Real | ___ / 5 | ___ % | [ ] Y [ ] N | |
Overall Goal Status: [ ] MASTERED (Met in ≥3 of 5 trials) [ ] IN PROGRESS (<3 trials met)
IEP Case Manager / Evaluator: __________________________
