At-Home Literacy Assessment Questionnaire Form
Complete this assessment to help evaluate literacy skills and reading habits at home. All responses are confidential and used solely for educational assessment purposes.
Learner's Full Name
*
First Name
Last Name
Age Group
*
4-6 years
7-9 years
10-12 years
13+ years
Primary Language Spoken at Home
*
Please Select
English
Spanish
French
Mandarin
Other
How often does the learner read at home (alone or with someone)?
*
Every day
Several times a week
Once a week
Rarely
Types of Reading Materials Used at Home
*
Storybooks
Comics/Graphic Novels
Magazines
Digital/E-books
Newspapers
Other
Self-Rated Literacy Skills
*
Rows
Not at all
A little
Somewhat
Very well
Reading words
1
2
3
4
Understanding stories
5
6
7
8
Reading aloud
9
10
11
12
Writing sentences
13
14
15
16
How much does the learner enjoy reading?
*
1
2
3
4
5
How confident does the learner feel about their reading skills?
*
1
2
3
4
5
Who usually helps the learner with reading at home?
*
Parent or guardian
Sibling
Tutor
No one
Other
Please share any additional comments about the learner's reading habits or needs.
Submit Assessment
Should be Empty: