Sample Phonological Awareness Diagnostic Assessment Form

Directions: Give the students an example of each task before proceeding with a new category. Some students may need two examples. Accept all responses. Do not proceed to the next category if the student cannot answer any of the items correctly in the category that preceded it. Place a check in the corresponding column for each item the student answers correctly.

Student's Name: _____________________________________

Awareness of Rhyme: Date Date Date
(Say "yes" if these two words rhyme.
Say "no" if they don't.)
     
  • cat    fat
  • bike    hike
  • go    door
  • come    run
  • candle    handle
  • man    moon
  • __________
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    (Tell me a word that rhymes with …)

         
  • hat
  • cake
  • pet
  • jump
  • kitten
  • __________
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    Awareness of Alliteration
    (Say "yes" if these words start with the same sound.
    Say "no" if they don't.)

         
  • big balloon
  • come colour
  • funny morning
  • __________
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    (I'll say a word and you tell me one that starts with
    the same sound.)

         
  • dog
  • silly
  • huge
  • __________
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    Ability to Blend and Segment Words
    (I'm going to say some words in a special way by
    stretching out the sounds. Put the sounds together
    and tell me what word they make.)

         
  • p....i....n
  • j....o....b
  • s....a....t
  • sh....oe
  • th....a....t
  • __________
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    (I'll say a word and you tell me the sounds you hear
    in it. You stretch the word into its sounds.)

         
  • keep
  • red
  • bump
  • snow
  • frost
  • __________
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