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Form Summary Sheet is an Excel spreadsheet that you can use to keep track of your form submissions. It is a very easy, user-friendly way to keep all of your form submission data in one place. Additionally, you can use the information from the Form Summary Sheet to create reports and track your progress over time. You can customize it to fit your specific needs, so it is perfect for any type of form submission project.

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Question	Answer
Form Name	Form Summary Sheet
Form Length	1 pages
Fillable?	Yes
Fillable fields	76
Avg. time to fill out	15 min 27 sec
Other names

12

Form Preview Example

Summary Form

Student ___________________________________________	Grade ____________	Benchmark Independent Level*	___________
		Benchmark Independent Level*	___________
Teacher ___________________________________________	Date _____________	Benchmark Instructional Level**	___________
School ____________________________________________		Recommended Placement Level	___________

Assessment Summary Form

Title

List the titles read by the student from lowest to highest level.

<![endif]>System 1 or 2	<![endif]>Fiction/ Nonfiction	<![endif]>Level	<![endif]>Accuracy	<![endif]>Comprehension	<![endif]>Independent * (check one)	<![endif]>Instructional * (check one)	<![endif]>Hard * (check one)

<![endif]>Self-Correction

<![endif]>Levels C–Z

<![endif]>Fluency

<![endif]>Levels J–Z (optional)

<![endif]>Rate

<![endif]>Reading (optional)

<![endif]>Writing About

<![endif]>Summary Forms

*Key for Determining Independent/Instructional/Hard Levels

Levels A–K

Comprehension Score

			Excellent	Satisfactory	Limited	Unsatisfactory
	<![endif]>Score		(6–7)	(5)	(4)	(0–3)
		95–100%	Independent	Independent	Instructional	Hard

	<![endif]>Accuracy	90–94%	Instructional	Instructional	Hard	Hard
		Below 90%	Hard	Hard	Hard	Hard

Levels L–Z

Comprehension Score

			Excellent		Satisfactory
			(9–10)		(7–8)
<![endif]>Score	98–100%		Independent		Independent
<![endif]>Score

<![endif]>Accuracy	95–97%		Instructional		Instructional
<![endif]>Accuracy	Below 95%		Hard		Hard
	Below 95%		Hard		Hard

Limited		Unsatisfactory
(5–6)		(0–4)
Instructional		Hard
Instructional		Hard
Hard		Hard
Hard		Hard

<![endif]>NH: Heinemann. This page may be photocopied.

Behaviors and Understandings to Notice, Teach, and Support (See The Continuum of Literacy Learning)

<![endif]>© 2011, 2008 by Irene C. Fountas and Gay Su Pinnell. Portsmouth,

Fountas & Pinnell Benchmark Assessment System 1

143

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Complete the de, poco, to, hp, e, by, a, mega, psi, hT, n, name, neH Levels, AK Comprehension, Score, Excellent Satisfactory, Limited, Unsatisfactory, Levels, LZ Comprehension, Score, Excellent Satisfactory, Limited, Unsatisfactory, e, roc, Sy, car, ucc, A Independent, Independent, and Instructional area with the particulars demanded by the software.

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