Academic Performance Questionnaire Chart
No. Question Response Score
(Yes/Rarely/No) (2/1/0)
1 Does the child complete homework
assignments on time?
2 Does the child show interest in reading and
writing activities?
3 Can the child follow instructions and
understand classroom lessons?
4 Does the child participate actively in class
discussions?
5 Is the child able to organize their
schoolwork and materials?
6 Does the child struggle with math concepts
or calculations?
7 Can the child express thoughts and ideas
clearly in writing?
8 Does the child have difficulty with reading
comprehension?
9 Is the child able to focus and stay on task
during lessons?
10 Does the child seek help when needed or
struggle with asking for help?
11 Can the child recall and retain information
learned in class?
12 Does the child have trouble with spelling or
writing words correctly?
13 Is the child able to solve problems
independently?
14 Does the child show frustration or anxiety
during academic tasks?
15 Can the child work collaboratively with
peers on group projects?
16 Does the child have difficulty with time
management or deadlines?
17 Is the child able to follow multi-step
instructions?
18 Does the child struggle with handwriting or
fine motor skills?
19 Can the child apply learned concepts to new
situations?
20 Does the child have trouble with
organization or assignments?
21 Is the child able to listen and follow
directions during lessons?
22 Does the child show a positive attitude
towards learning?
23 Can the child use technology effectively for
learning purposes?
24 Does your child have trouble adjusting to
new classroom routines or schedule?
25 Does your child know what they did well
and what they need to improve after
completing a task?
Total Score
Scoring and Interpretation
Yes = 2 points
Rarely = 1 point
No = 0 points
Interpretation of Scores
45–50 points: Strong academic performance; additional support likely
unnecessary.
30–44 points: Some strengths, but may benefit from targeted support.
Below 30 points: Significant challenges; comprehensive assessment and
support recommended.