Literacy Group Entry Placement Form

Purpose: This form helps us determine whether a small-group literacy program is appropriate for your child, and which group would best match their current skills.

Child & Family Details

Child's Name *

Date of Birth *

School Year Level *

School Name (Optional)

Parent/Caregiver Name *

Contact Email/Phone *

Attendance & Group Readiness

Please answer as best you can. "Unsure" is okay.

My child can sit and participate in a structured activity for 10–15 minutes with adult support. *

YesNoUnsure

My child can follow two-step instructions (e.g. “Get your book and sit on the mat”). *

YesNoUnsure

My child can take turns and wait briefly when working with other children. *

YesNoUnsure

My child can participate in a small group without becoming distressed or overwhelmed. *

YesNoUnsure

My child does not require one-to-one support to manage emotions or behaviour. *

YesNoUnsure

⚠️ If several items are marked “No”, individual therapy may be more appropriate than a group program at this stage.

Literacy Skills - What Does Your Child Currently Do?

Please answer as best you can. "Unsure" is okay.

Letter & Sound Knowledge

My child knows most basic letter sounds (e.g. s, a, t, p, i, n). *

YesNo Unsure

My child can say the sound a letter makes (not just the letter name). *

YesNo Unsure

My child knows trickier vowel combinations like ay, ee, er, oa. *

YesNo Unsure

Blending & Early Reading

My child can blend 3 sounds together to read simple words (e.g. c-a-t → cat). *

YesNo Unsure

My child attempts to sound out unfamiliar words rather than guessing. *

YesNo Unsure

My child can read some simple words independently. *

YesNo Unsure

My child struggles to read words with 4 or more sounds. *

YesNo Unsure

My child struggles to read bigger words. *

YesNo Unsure

Spelling & Writing (Optional)

My child can write some letters correctly.

YesNoUnsure

My child attempts to spell simple words using sounds they hear (e.g. “kat” for cat).

YesNoUnsure

My child can consistently spelling 3 letter words but not 4 or 5 letter words.

YesNoUnsure

My child struggles with trickier vowel spellings or longer words.

YesNoUnsure

Exclusion & Fit Check

My child has significant emotional or behavioural difficulties in group settings. *

YesNo

My child currently requires one-to-one support to participate in learning tasks. *

YesNo

My child is already feeling highly overwhelmed by school literacy demands. *

YesNo

⚠️If “yes” to any of the above, group placement may not be recommended at this time.

Commitment & Expectations

I understand this is a small group program, not individual therapy. *

YesNo

I can commit to weekly attendance for the full term block. *

YesNo

I am willing to support brief home practice between sessions. *

YesNoUnsure

Parent Comments (Optional)

Is there anything else you’d like us to know about your child’s literacy skills or learning needs?