SECTION A: Demographics/Grade/Term

1. Gender (Required)

Male

Female

To be determined

2. Age (Required)

3. Grade (Required)

4. Term (Required)

SECTION B: Own reading practices

1a) Do you think you are a good reader? (Required)

1b) How do you know if you are a good reader? (Required)

2a) What do you find difficult to read? What makes it difficult? (Required)

2b) What do you find easy to read? What makes it easy? (Required)

3. What is the last book that you really enjoyed reading? Why? (Required)

4a) How do you know when you don't understand what you are reading? (Required)

4b) When you have difficulty understanding what you are reading, what do you do? (Required)

5. How do you choose books to read? (Required)

6. How often do you read when you are not at school?   (Required)

7.  What kind of reading do you do using technology? (Required) Mention as many that apply to you.(e.g. Email, Chat, Websites, CDROMs etc..)

SECTION C: Struggling reader practices (own and others)
Good reader assistance possible)

8a) If you knew someone was having difficulty reading a story, how could you help? (Required)

8b) If you knew someone was having difficulty reading an information article, how could you help?  (Required)

9. Think of someone who is a good reader. What do you think makes that person a good reader?  (Required)

10. What do you think a good reader does when the text doesn't make sense?  (Required)

11a) When you are reading and you come to a WORD you don't know, what do you do? Do you ever do anything else? (Required) (EXAMPLES: recognize by sound(phonemics), look(visualize), meanings(morphemics), connections (e.g. know about a word (prefix, suffix) can guess), inquiry (e.g. dictionary, thesaurus))

11b) Which of these strategies do you use most often to understand words? (Required)

SECTION D: Other (alternate languages and recommendations)                     

12.   Do you read in any other language (s) home or at school? Which one (s)? (Required) 

13a) As a reader, what would you like to do better? (Required)

13b) How can the teacher help? (Required)

SECTION E: CASI Scores on 4 dimensions and Reading Level (optional)

1. CASI Results 

a) Application of Language Conventions (#4) 
    (grammar, punctuation,recognize sentence/word order,patterns)

b) Organization of Ideas (#5)
    (recognize and use different forms of text,  eg fiction/nonfiction) 

c) Reasoning (#7) 
    (interprets & analyzes meaning) 

d) Communication (#8)
     (explain, support & apply what read, personal experiences)

2. OVERALL:

a) SCORE:

b) LEVEL: