Written Formative Assessment

CIR 412 Formative Assessment Form

Please remove all italicized directions throughout the document before submitting.

Student’s Name (First Only):

School:

Examiner:

Age:

Grade:

Date of Assessments (may take multiple days; list each assessment with corresponding date):

Directions: Record all significant summary information collected from assessments. List N/A if an assessment was not applicable/possible for the grade level.

Part I: Assessment of Interests and Motivations

Summary of Student’s interests and/or motivations for reading (up to 2 brief paragraphs):

Summary of Student’s background knowledge (up to 1 brief paragraph):

Please note: Hopefully, you will be able to learn about your student from the mentor and other teachers at the school. You may also include information you have gleaned from your interactions with the student.

Informal evaluation of oral language and verbal skills (up to 1 brief paragraph):

Part II: Phonological Awareness/Phonics and/or Spelling Assessment

You may find that you need to use the PAST to assess phonological awareness or The Phonics and Word Reading Survey if your student struggles in these areas. If so, include information on those results.

PAST/Phonics Word Reading information (up to 1 brief paragraph explaining the assessment tool used & results):

Tutoring Recommendations based on PAST/Phonics Word Reading (up to 2 brief paragraphs discussing what specific areas to focus on for tutoring based on PAST/Phonics. Ex: 1 paragraph on blending phonemes and 1 paragraph on long vowels)

Words Their Way Spelling Assessment information (up to 1 brief paragraph explaining the assessment tool used):

Fill in chart below: (include # possible on each Ex: 3/10)

	Blends and Digraphs	Vowels	Complex Consonants	Inflected Endings and Syllable Juncture	Unaccented Final Syllables	Affixes	Reduced Vowels in Unaccented Syllables	Greek and Latin Elements	Assimilated Prefixes	Feature Points	Words Spelled Correctly
Totals

Tutoring Recommendations based on Spelling Assessment (up to 2 brief paragraphs discussing what specific areas to focus on for tutoring based on spelling assessment. For instance, 1 paragraph on Greek/Latin Roots and 1 paragraph on Inflected Endings)

Part III: Reading Vocabulary, Fluency, and Comprehension

(List the version for each assessment. Ex: 3.1)

Fluency & Vocabulary:

Word Reading Fluency:

Passage Reading Fluency:

Comprehension:

Multiple Choice Reading Comprehension:

Oral Language and Vocabulary Observations (up to 1 brief paragraph)

Part IV: Instructional Implications (IF-THEN Analyses)

Student Strengths:

List and explain at least 2 strengths you noticed with your tutoring student. (at least 2 brief paragraphs. 1 paragraph per strength.)

Areas of Focus for ILP:

List and explain at least 3 INSTRUCTIONAL weaknesses you noticed with your tutoring student. These will be the focus of your tutoring sessions lessons. Do not focus on behavioral or motivational concerns/weaknesses Ex: easily distracted, doesn’t like to read, attention issues, etc.(at least 3 brief paragraphs. 1 paragraph per weakness)

Part V: Tutoring Sessions Overview

Tutoring Session Number & Area of Focus Addressed	Opening Activity (1-3 Minutes)	Area of Focus Addressing Weakness 1, 2, or 3 (10-15 minutes)	Closing Activity (1-3 minutes)	Reading component(s) addressed
1 (Ex: Morphemes for Vocabulary)
2
3

*Post-Tutoring reassessment and Summative Report Writing to take place after sessions end

Please note the above is a plan. For the formative assessment report, you will fill this out with your initial ideas for a tutoring plan based on your assessments and the 5 components of reading. Once you have completed all sessions, you will revise/fill this chart out for the summative assessment report with what you actually did in your tutoring sessions.