Early Language, Literacy, and Numeracy Assessment Form

Please provide the following information:

Child's Name:
Child's Age:
Grade:
Parent/Guardian's Name:
Contact Number:

Section 1: Language Skills

Please rate the following aspects of the child's language skills on a scale of 1
to 5, with 1 being the lowest and 5 being the highest:

Vocabulary development:
Limited (1)
Developing (2)
Adequate (3)
Proficient (4)
Advanced (5)

Sentence structure and grammar:

Limited (1)
Developing (2)
Adequate (3)
Proficient (4)
Advanced (5)

Expressive language (ability to communicate ideas and thoughts):

Limited (1)
Developing (2)
Adequate (3)
Proficient (4)
Advanced (5)

Section 2: Literacy Skills

Please indicate the child's progress in the following literacy skills:

Letter recognition (knowledge of letters):

Needs Improvement
Beginning to Recognize
Recognizes Most Letters
Recognizes All Letters
Phonics awareness (understanding the relationship between letters and
sounds):
Needs Improvement
Beginning to Understand
Understands Basic Phonics
Advanced Phonics Knowledge

Sight word recognition (knowledge of commonly used words):

Needs Improvement
Beginning to Recognize
Recognizes Some Sight Words
Recognizes Many Sight Words

Section 3: Numeracy Skills

Please rate the child's numeracy skills on a scale of 1 to 5, with 1 being the
lowest and 5 being the highest:

Counting and number recognition:

Limited (1)
Developing (2)
Adequate (3)
Proficient (4)
Advanced (5)

Basic arithmetic operations (addition, subtraction):

Limited (1)
Developing (2)
Adequate (3)
Proficient (4)
Advanced (5)

Number sense (understanding the relationship between numbers):

Limited (1)
Developing (2)
Adequate (3)
Proficient (4)
Advanced (5)

Section 4: Additional Comments

Please provide any additional comments, observations, or concerns
regarding the child's early language, literacy, and numeracy skills:
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Thank you for taking the time to complete this form. Your feedback is greatly
appreciated!