TOLD 5 Assessment Form
Complete this assessment form with the details needed to capture the TOLD 5 evaluation. Keep the title exactly as shown across the form.
Assessment Details
Respondent Name
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor/Evaluator Name
*
Assessment Context
*
Initial Screening
Progress Monitoring
Diagnostic Evaluation
Reassessment
Other
TOLD 5 Assessment Items
TOLD 5 Assessment Items
*
Rows
Not Observed
Below Expectation
Meets Expectation
Exceeds Expectation
Item 1
1
2
3
4
Item 2
5
6
7
8
Item 3
9
10
11
12
Item 4
13
14
15
16
Item 5
17
18
19
20
Overall scoring confidence
*
1
2
3
4
5
Assessment administration format
*
Please Select
In-person
Remote
Mixed
Other
Assessment date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Scoring notes
Overall Result
Overall Performance Rating
*
1
2
3
4
5
Summary Notes / Observations
Submit
Should be Empty: