Are you taking this test for yourself or someone else?

Self
Someone else

How old are you?  [Slide bar left or right until the appropriate age is displayed.]

The age of the person being screened?   [Slide bar left or right until the appropriate age is displayed.]

Question

 

Yes
No
Sometimes
Unknown
N/A

The student may be struggling with some areas of literacy development. Additional instruction or intervention may be helpful. If difficulties continue after additional support, an assessment is recommended.

Indicators ()	Response

Disclaimer: This informal screening is not a diagnosis of dyslexia. This screening form can be used to assist in identifying characteristics of dyslexia. One or more Yes responses in Primary Indicators and a significant number of Yes responses in other categories may indicate the need for further assessment and reading support.