Literacy Assessment History Form
Please complete the Literacy Assessment History Form to help us understand your previous experiences and comfort with literacy assessments.
Full Name
*
First Name
Last Name
Age
*
Highest Grade Level Completed
*
Please Select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Post-secondary
Other
Have you previously completed a formal literacy assessment?
*
Yes
No
Not Sure
Type(s) of Literacy Assessment Completed
Reading Comprehension
Writing Skills
Spelling
Phonics
Vocabulary
Other
When was your most recent literacy assessment?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate your comfort level with reading and writing tasks?
*
1
2
3
4
5
Please indicate how frequently you engage in the following activities:
Rows
Never
Rarely
Sometimes
Often
Always
Reading books
1
2
3
4
5
Writing essays or stories
6
7
8
9
10
Spelling practice
11
12
13
14
15
Vocabulary exercises
16
17
18
19
20
Preferred learning method for improving literacy skills
One-on-one instruction
Small group sessions
Online self-paced modules
Workshops or seminars
Other
Please share any additional comments about your literacy assessment history.
Submit
Should be Empty: