Educational Psychologist Assessment Report

1. Personal Information

Name

Date of Birth

Date of Assessment

School / Institution

Year / Grade

2. Reason for Referral

3. Background Information

a) Developmental History

b) Educational History

c) Family / Social Background

d) Medical / Health History

4. Assessment Methods & Tools

5. Observations

6. Assessment Results

a) Cognitive Assessment

b) Academic Achievement

c) Social-Emotional / Behavioral

d) Other Relevant Findings

7. Summary and Conclusions

8. Recommendations

9. Signatures

Assessor

Date