08/18/2026
Scholar Name
Test Scholar
Scholar Grade
5th
Site Location
Auburn Elementary
Site Coordinator
Test Coordinator
Tutor Name
Test Tutor
Forms to be submitted
  • Scholar Assessment
  • Scholar Pre-Assessment
  • Tutor Session Report
Scholar Assessment
RLS RETELLING STORY: “The Broken Crayon”
Instructions: Scholar follows along while tutor reads

Maya loved to draw at school. One day, her favorite blue crayon snapped in half.
“Oh no!” Maya said. What am I going to do?”

Maya felt upset and stopped drawing. Her friend Jordan noticed and asked,
“Why aren’t you drawing today?” Maya sighed and said, “My blue crayon broke.”
Jordan smiled and said, “That’s okay! We can share!”

Jordan gave Maya a blue crayon and said, “Let’s draw together!” Maya smiled and started drawing again. She learned that sharing can make hard days better.

RLS PROSODY

“Oh no!” Maya said.
“What am I going to do?”

Jordan smiled and said,
“That’s okay! We can share!”

Jordan gave Maya a blue crayon and said,
“Let’s draw together!”

RLS WORD RECOGNITION
Instructions: Tutors select the letters or words missed.
RLS LEVEL PRE-A
  • No letters missied
RLS LEVEL A
  • No words missied
RLS LEVEL B
  • No words missied
Fry 100
  • other
Fry 200
  • No words missied
Fry 300
  • mountains
Fry 400
  • across
  • birds
Fry 500
  • government
Fry 600
  • No words missied
Fry 700
  • surprise
Fry 800
  • No words missied
Fry 900
  • position
  • army
Fry 1000
  • No words missied
Fry 1100
  • symphony
Scholar Pre-Assessment
RLS RETELLING
Instructions: Tutor reads to the scholar (with prosody).
ASSESSMENT STORY: “The Broken Crayon”

ASSESSMENT STORY: “The Broken Crayon”

Maya loved to draw at school.
One day, her favorite blue crayon snapped in half.
“Oh no!” Maya said.
What am I going to do?”
Maya felt upset and stopped drawing.

Her friend Jordan noticed and asked,
“Why aren’t you drawing today?”
Maya sighed and said,
“My blue crayon broke.”
Jordan smiled and said,
“That’s okay! We can share!”

Jordan gave Maya a blue crayon and said,
“Let’s draw together!”
Maya smiled and started drawing again.
She learned that sharing can make hard days better.

RLS RETELLING — RLS TUTOR PROMPT

RLS RETELLING — RLS TUTOR PROMPT

“Tell me what happened in the story.”

Retelling Assessment
  • Retold beginning, middle, and end sequentially
  • Used all cue words (beginning, middle, end, and first, next, then)
  • Included details beyond one sentence
  • Used cause/effect language (because / so / why)
  • Stated the lesson or message
RLS 1, 2, 3 POV Level
Level 3
RLS PROSODY – 1, 2, 3, POV Storytelling with Me
Instructions: Have scholar read the following. Tutor reads aloud | Non‑reader echo‑reads.

“Oh no!” Maya said.
“What am I going to do?”

Jordan smiled and said,
“That’s okay! We can share!”

Jordan gave Maya a blue crayon and said,
“Let’s draw together!”

POV Assessment
  • 1 POV - Phrasing — grouped words into meaningful chunks
  • 2 POV – Punctuation - voice changed for punctuation (?, !)
  • 3 POV – Storytelling Voice — voice changed to sound different for every character
Retelling Level
Level 3
RLS WORD RECOGNITION
Instructions: Tutors select the letters or words missed.
RLS LEVEL A — (10 words)
  • No words missied
RLS LEVEL B — (10 words)
  • No words missied
RLS Level 100 - 1000 (20 words per band)

RLS Level 100 - 1000 (20 words per band)

Rule: 0–2 incorrect → UP | 3 incorrect → STOP | 3+ incorrect → DOWN

Fry 100
  • No words missied
Fry 200
  • No words missied
Fry 300
  • enough
Fry 400
  • certain
Fry 500
  • scientists
Fry 600
  • discovered
Fry 700
  • fraction
Fry 800
  • information
Fry 900
  • compound
Fry 1000
  • determine
  • especially
Fry 1100
  • podiatrist
Final WORD RECOGNITION ENDING LEVEL
3
RLS TUTOR FINAL PLACEMENT SUMMARY
RLS Word Recognition Level
3
RLS 1, 2, 3 POV Level
3
RLS Retelling Level
3
SITE COORDINATOR REVIEW
  • Placement confirmed
  • Adjusted
Adjusted (reason)

Testing

Tutor Session Report
Sections to be submitted
  • Word Recognition
  • Fluency - Prosody & Accuracy
  • Comprehension - Retelling
Word Recognition Section
Beginning Word Level
1100 (Nifty Fifty)
Ending Word Level
1100 (Nifty Fifty)
Missed Words
  • None
Fluency Accuracy Section
1 = Did not display
2 = Displays sometimes
3 = Always displays
Expression
3
Phrasing
3
Intonation
3
Comprehension - Retelling Section
Did they use cue words?
  • Beginning
  • Middle
  • End
  • First
  • Next
  • Then
Did the scholar retell the story in chronological order?
Yes
If the scholar did not retell the story in chronological, which part do they need help with?
  • The scholar does not need help with retelling the beginning, middle, or end of the story
Behavior Section
For each prompt, write any behavior you observed
How was Scholar's behavior?
  • Engaged/On-task
Does this require immediate attention from the Program Director?
No
Any other notes on this scholar's behavior?

Testing scholar notes

Final Submission
Is everything correct?
Everything submitted is true to the best of my ability
Yes everything is correct
Date Created
August 18, 2026
Date Updated
August 18, 2026