Early Childhood Reading Impact Survey Form
Share observations about how early childhood reading affects a child’s engagement, enjoyment, and learning.
Child Background
Child's age range
*
0-2 years
3-4 years
5-6 years
7 years or older
How many days per week does the child read at home?
*
Please Select
0 days
1-2 days
3-4 days
5-6 days
Every day
Primary language used at home
*
English
Spanish
Bilingual (English and another language)
Other
Reading Environment
Who most often reads with the child?
*
Parent or guardian
Sibling
Grandparent
Teacher or caregiver
Other
Typical reading setting
*
At home
At school or childcare
At a library
In the car or while traveling
Other
Average reading session length
*
Less than 10 minutes
10-20 minutes
21-30 minutes
More than 30 minutes
Varies
Reading Impact Survey
Observed impact ratings
*
Rows
1 - Strongly Disagree
2
3
4
5 - Strongly Agree
Attention span during story time
1
2
3
4
5
Enjoyment of reading
6
7
8
9
10
Vocabulary growth
11
12
13
14
15
Requests for books
16
17
18
19
20
Notable observations or changes
Overall reading impact
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
How would you rate the child's interest in reading?
1
2
3
4
5
Submit Survey
Should be Empty: