Child's Name Parent/Guardian Name Date

Does your child show interest in books? Yes No Sometimes How often do you or someone else read to your child? Daily Several times a week Once a week Rarely What are your child's favorite books or stories?

Can your child recognize any letters? Yes No Some letters Does your child point to words or pictures when being read to? Yes No Sometimes Can your child recognize or use rhyming words? Yes No Sometimes

What are your child's favorite literacy-related activities? Do you have any concerns about your child's early literacy development? Additional Comments