Minnesota Handwriting Assessment Record Form

Ñame _ Date
School
Teacher Examiner
Grade Circle the marking period that most closely matches the assessment date.
1s,Grade 1SI Grade 2nd Grade 2"d Grade 2nd Grade
January April October January April

Rate Legibility Form Alignment Size Spacing

Score Score Score Score Score Score
1st
• • • • • • • • • •
Grade
January April january-April January-April January Aprit January-April January-April

18-34 22-34 33-34 30-34 29-34 29-34 27-34 30-34

Performing
Like Peers
O O O O O O O O
Performing 11-17 13-21 32 25-29 20-28 22-28 15-26 26-29
Somewhat
Below Peers O O O O O O O O
10 or 12 or 31 or 24 or 19 or 21 or 14 or 25 or
Performing fewer fewer fewer fewer fewer fewer fewer fewer
Well Below
Peers O O O O o: O O O

Rate Legibility Form Alignment Size I Spacing

Score Score Score Score Score Score
2nd
• • • • • • • •
Grade
October January April Qctober-Aprjl October-April October-April October-April October-April

26-34 29-34 33-34 34 31-34 31-34 27-34 32-34

Performing
Like Peers
O O O O O O O O
Performing 15-25 17-28 20-32 32-33 28-30 26-30 19-26 29-31
Somewhat
Below Peers O O O O O O O O
14 or 16 or 19 or 31 or 27 or 25 or 18 or 28 or
Performing fewer fewer fewer fewer fewer fewer : fewer fewer
Well Below
Peers O O) O O O O O O
Copyright © 1999 NCS Pearson, Inc. / All rights reserved.
Minnesota Handwriting Assessment/ Judith Reísman/ ISBN 0761637001 /800-211-8378/This page is reproducible.

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 Minnesota Handwriting Assessment Record Form

A d d i t i o n a l observations: Check all those that appiy.

D Uncoordinated finger movements D Erasures créate holes in paper
D Tremors of the hands/fingers • Written work is messy
D Limited movement in fingers/wrist/elbow • Rests head when writing
D Inappropriate grasp of pencil D Squints during writing tasks
D Frequent adjustment of grasp during writing D Poor trunk stability
D Too light/too heavy pencil pressure G Poor sitting balance
D Changes hands during writing task D Easily distracted when writing

Comments

Recommendations

Progress: Performs Test 1 : Test 2: Test 3:

Rate Like Peers
Somewhat Below Peers
Well Below Peers
Legibility Like Peers
Somewhat Below Peers
Well Below Peers
Form Like Peers
Somewhat Below Peers
Well Below Peers
Alignment Like Peers
Somewhat Below Peers
Well Below Peers
Size Like Peers
Somewhat Below Peers
Well Below Peers
Spacing Like Peers
Somewhat Below Peers
Well Below Peers

Copyright © 1999 NCS Pearson, Inc. / All rights reserved.

Minnesota Handwriting Assessment / Judith Reisman / ISBN 0761637001 / 800-211 -8378 / This page is reproducible.

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