Mathematics Learning Difficulty Assessment
Please complete this form to help us assess areas of difficulty in learning mathematics.
Student Name
*
First Name
Last Name
Age
*
Grade Level
*
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
High School
Other
Please indicate how often the student experiences the following difficulties in mathematics.
*
Rows
Never
Rarely
Sometimes
Often
Always
Has trouble understanding math instructions
1
2
3
4
5
Makes frequent calculation errors
6
7
8
9
10
Struggles with word problems
11
12
13
14
15
Finds it hard to memorize math facts
16
17
18
19
20
Has difficulty with mental math
21
22
23
24
25
How confident does the student feel about their math abilities?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which mathematical areas does the student find most challenging? (Select all that apply)
*
Addition/Subtraction
Multiplication/Division
Fractions/Decimals
Geometry
Word Problems
Other
Does the student use any learning supports or accommodations in mathematics?
*
Yes
No
Please rate the student's overall attitude toward mathematics.
*
1
2
3
4
5
In your own words, describe any specific difficulties or strengths observed in the student's approach to mathematics.
Is there any additional information you would like to share regarding the student's learning in mathematics?
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