ASSESSMENT RECORD SHEET

Student’s Name:
Age: Birthday
Counting Forward (14 points)
Count from 11 to 20
Circle all the numbers that were said in the right sequence.
11 12 13 14 15 16 17 18 19 20 Total:
Circle all the (bolded and underlined) numbers that were given correctly.
8, 9, 17, 18, 45, 46, 79, 80 Total:
Counting Backward (10 points)
Circle all the numbers that were given correctly
10 9 8 7 6 5 4 3 2 1 Total:
Circle all the numbers that were given correctly.
20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Total:
Reading Numbers (6 points)
Circle all the numbers that were read correctly
4 7 47 74 15 50 Total:
Writing Numbers (13 points)
Circle all the numbers that were written correctly
6 7 9 4 0 8 12 14 19 25 33 67 100 Total:
Matching Numbers and Sets (10 points)
Circle all the numbers and sets that were matched correctly.
0 2 5 7 9 11 13 16 18 20 Total:
Ordering Numbers (10 points)
Did the student arrange the numbers in the right order? _ Yes _ No
Circle all the numbers that were in the correct order:
0 2 5 7 9 11 13 16 18 20
If the numbers are not in the correct order, how were the numbers arranged?
_
Total:
NUMBER SENSE: ADDITION AND SUBTRACTION
Build and Change Numbers (12 points)
Please put a  mark. (Scoring: Give one point for each check mark in Y for the correct answer, can
predict, and the correct use of counters.)
Can predict? Used counters correctly?
Changed 4 to 8 Correct answer? Y N Y N Y N
Changed 6 to 3 Correct answer? Y N Y N Y N
Changed 5 to 9 Correct answer? Y N Y N Y N
Changed 9 to 2 Correct answer? Y N Y N Y N
Total:

ABILITY GROUPINGS TOTAL SCORE (out of 75 items)

Full Intervention (64% and below) 48 and below
Moderate Intervention (65 - 79%) 49 – 59
Light Intervention (80 - 94%) 60 – 70
Grade Ready (95-100%) 71 – 75
 NUMBER CARDS
(For Matching Numerals and Sets and Ordering Numbers)
(Please cut into individual cards)

0 2
5 7
 9 11
13 16
18 20
DOT CARDS (For Matching Numbers and Sets)
(Please cut into individual cards)
 NUMERAL CARD (For Reading Numbers)

4 47
74 15
7 50
Math Assessment Tool Rubric (Teacher’s Self-Evaluation)
Put a check under YES or NO.

General
General Procedure-related Questions YES NO

1. Did I greet the child?

2. Did I tell him/ her the purpose of our task and that is to know what he/ she knows about numbers?

3. Did I use a friendly tone?

4. Did I use the child’s mother tongue when talking to him/her?

5. Was I able to put the child at ease with the initial questions about him/her?

6. Did I have a neutral facial expression whether the child’s answer is correct or wrong?

7. Did I use all the necessary learner’s sheets/ stimuli?

8. Did I accomplish all the record sheets correctly?

Counting Forward

Procedure-related Questions YES NO

1. Did I ask the child how high he/she can count?

3. Did I record the child’s answers and take note of the proper sequence of the numbers?

4. Did I read the numbers clearly and slowly?

5. Did I mark all numbers answered correctly with a check (✔️)?

6. Did I count and write the total score?

Counting Backward

Procedure-related Questions YES NO

1. Did I ask the child to count backwards from 10?

2. Did I give the starting hint when the child did not understand “counting backwards”?

3. Did I ask the child to count backwards from 20?

4. Did I record the child’s answers and take note of the proper sequence of the numbers?

5. Did I count and write the total score?

Reading Numerals

Procedure-related Questions YES NO

1. Did I point to the numbers in the numeral card in the correct sequence?
 2. Did I take note of the errors in reading the numbers and wrote it in the record sheet?

4. Did I circle all the numbers that were read correctly?

5. Did I count and write the total score?

Writing Numerals

Procedure-related Questions YES NO

1. Did I give the child a blank sheet of paper and pencil?

2. Did I read the numbers clearly and slowly?

4. Did I circle all the numbers that were written correctly?

5. Did I count and write the total score?

Matching Numerals and Sets

Procedure-related Questions YES NO

1. Did I give the instructions clearly?

2. Did I show the dot cards in random order?

3. Did I take note of all the correct matches and give a score of 1 per correct answer/match?

4 Did I take note whether the student counted the dots or not and wrote it in the record sheet?

5. Did I count and write the total score?

Ordering Numbers

Procedure-related Questions YES NO

1. Did I remove the 0 card and randomly arranged the number cards?

2. Did I give the instructions clearly?

3. Did I give enough time for the child to do the task and ask if he/she is done arranging the cards?

4. Did I ask where the 0 card should be placed?

5. Did I mark what number cards were in the proper sequence?

6. Did I count and write the total score?

Build and Change Numbers (Addition and Subtraction)

Procedure-related Questions YES NO

1. Did I give the child his/her materials – counters?

2. Did I place the correct number of counters on the table?

3. Did I ask the question clearly and not give the next instruction immediately?

4. Did I take note in my record sheet if the student was able to visualize and explain first how to build and
change numbers?

5. Did I give the instruction to build and change numbers clearly?

6. Did I mark all correct answers with a check (✔️) on the record sheet?

7. Did I count and write the total score?