Phonics Intake Assessor Protocol
Teacher Protocol LLD / Cognitive Tier 2-3
Phonics Diagnostic Intake Protocol
Grades 2–4 Special Education Baseline & Progress Monitoring
Form ID: LLD-PHN-24
Target Administration: 12–18 mins
1:1 Proctored Screen
Student Name
Grade / Placement
Assessor / Date
Primary Modality
Verbal Pointing AAC
1 Name Writing & Orthographic Motor Screen
Script: "Write your first and last name on page 1 of your booklet."
Grip / Dominance
[ ] Tripod [ ] Palmar
[ ] Left [ ] Right hand
Case Conventions
[ ] Title case (John)
[ ] ALL CAPS / Mixed
Letter Formation
[ ] Correct trajectory
[ ] Reversals (b/d/p)
Spatial Control
[ ] On baseline
[ ] Drifts / Floating
Score ___ / 4 pts
2 Phonological & Phonemic Awareness Battery
Discontinue after 3 consecutive errors per subtest
| Subtest & Scripted Prompt | Stimulus Items & Target Response | Observed Response | Score |
|---|
| A. Rhyme Recognition "Do these words rhyme? bed / red" | 1. bat/hat (Y) 2. sun/man (N) | | |
| 3. fish/wish (Y) 4. dog/log (Y) | 1[ ] 2[ ] 3[ ] 4[ ] | ___ / 4 | |
| B. Syllable Segmentation "Clap or tap the parts in: tiger (ti-ger = 2)" | 1. pan-cake (2) 2. el-e-phant (3) | | |
| 3. pup-py (2) 4. cat-er-pil-lar (4) | 1[ ] 2[ ] 3[ ] 4[ ] | ___ / 4 | |
| C. Phoneme Isolation (Initial / Final) "What is the first sound in soap? /s/" | 1. /m/ in map 2. /b/ in boat | | |
| 3. /t/ at end of net 4. /k/ at end of pack | 1[ ] 2[ ] 3[ ] 4[ ] | ___ / 4 | |
| D. Phoneme Blending (3 sounds) "Listen: /f/ /i/ /sh/. What is the word?" | 1. /s/ /u/ /n/ (sun) 2. /m/ /a/ /t/ (mat) | | |
| 3. /l/ /e/ /g/ (leg) 4. /r/ /o/ /k/ (rock) | 1[ ] 2[ ] 3[ ] 4[ ] | ___ / 4 | |
| E. Phoneme Segmentation "Tell me all the sounds in: pin (/p/ /i/ /n/)" | 1. mop (/m/ /o/ /p/) 2. bed (/b/ /e/ /d/) | | |
| 3. cup (/k/ /u/ /p/) 4. jam (/j/ /a/ /m/) | 1[ ] 2[ ] 3[ ] 4[ ] | ___ / 4 | |
3 Vowel Sound Identification (Short & Long)
Student Plate Card 1 • Mark: ✓ = accurate, O = error, SC = self-correct
Letter A a
Short /æ/ (apple): Long /eɪ/ (acorn):
Letter E e
Short /ε/ (egg): Long /iː/ (eagle):
Letter I i
Short /ɪ/ (igloo): Long /aɪ/ (ice):
Letter O o
Short /ɒ/ (octopus): Long /oʊ/ (ocean):
Letter U u
Short /ʌ/ (umbrella): Long /juː/ (unicorn):
Page 1 of 3: Phonological Screen & Vowels Next: CVC & CVCe Decoding Matrices • Turn to Page 2
Part B • Decoding & Fluency Probes
CVC, CVCe & Connected Text Fluency Screen
Student: ____________________ Date: ________
4
CVC Decoding (Real & Pseudo-Words)
Student Plate Card 2 • Direct student: "Read these words across the row."
Real CVC Words Points: ___ / 15 sounds
<table class="w-full text-[10px]"><tbody><tr class="border-b border-slate-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">1. cat</td><td class="font-mono text-[9px]">/k/ /æ/ /t/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="border-b border-slate-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">2. sip</td><td class="font-mono text-[9px]">/s/ /ɪ/ /p/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="border-b border-slate-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">3. mud</td><td class="font-mono text-[9px]">/m/ /ʌ/ /d/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="border-b border-slate-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">4. net</td><td class="font-mono text-[9px]">/n/ /ε/ /t/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">5. rot</td><td class="font-mono text-[9px]">/r/ /ɒ/ /t/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr></tbody></table>
Nonsense Words (Alien) Points: ___ / 15 sounds
<table class="w-full text-[10px]"><tbody><tr class="border-b border-amber-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">1. vag</td><td class="font-mono text-[9px]">/v/ /æ/ /g/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="border-b border-amber-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">2. pem</td><td class="font-mono text-[9px]">/p/ /ε/ /m/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="border-b border-amber-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">3. zib</td><td class="font-mono text-[9px]">/z/ /ɪ/ /b/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="border-b border-amber-100 text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">4. kog</td><td class="font-mono text-[9px]">/k/ /ɒ/ /g/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr><tr class="text-slate-600"><td class="font-mono font-bold text-slate-900 py-0.5">5. lup</td><td class="font-mono text-[9px]">/l/ /ʌ/ /p/</td><td class="text-right"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"><input type="checkbox" class="scale-75"></td></tr></tbody></table>
5
CVCe "Magic E" Decoding (Long Vowels)
Student Plate Card 2 • Check if student says long vowel sound
Real CVCe Words Total Correct: ___ / 5
bake /eɪ/
ripe /aɪ/
robe /oʊ/
mule /juː/
Pete /iː/
Nonsense CVCe Words Total Correct: ___ / 5
vate /eɪ/
jope /oʊ/
kife /aɪ/
mube /juː/
sede /iː/
Error Analysis Check: [ ] Reads short vowel (e.g., 'bak' for 'bake') [ ] Pronounces final 'e' as separate sound [ ] Ignores vowel; guesses by initial consonant
6
1-Minute Controlled Fluency Passage
Student Plate Card 3 • Start 60s timer at first word
Sam has a red pet fox. The fox is fast. [10 words]
The fox can hop on a big log in the mud. [21 words]
Sam gave the pet fox a ripe bone. [29 words]
The fox will hide the bone in a deep hole. [39 words]
Sam smiled and waved as the fox ran home. [48 words]
Total Words Read _____ / 48
Errors / Skips - _____
WCPM (Rate) = _____ WCPM
Accuracy % _____ %
Tracking Behavior: [ ] Finger pointing fluent [ ] Line skipping / jumps
Expression / Prosody: [ ] Word-by-word robot [ ] Phrased / Inflected
Self-Correction: [ ] Attempts re-read when confused [ ] Unaware of miscues
Page 2 of 3: Decoding & Fluency Scoring Next: Diagnostic Profile & Support Matrix • Turn to Page 3
Diagnostic Synthesis
LLD & Cognitive Phonics Profile & Tiering
Student: ____________________
7 Cognitive & Attentional Observations During Intake
| Domain | Observed Indicator | Severity / Impact |
|---|
| Processing Speed / Latency | Needs 5–10s wait time before phoneme verbalization; rapid fatigue after >8 items. | [ ] Mild [ ] Moderate [ ] High |
| Visual Crowding & Scanning | Loses track on multi-line text; needs reading tracker / isolate card; eye flutter. | [ ] Mild [ ] Moderate [ ] High |
| Auditory Working Memory | Retains 2 sounds in isolation but forgets initial phoneme upon blending 3rd sound. | [ ] Mild [ ] Moderate [ ] High |
| Frustration Tolerance / Stamina | Disengages or shuts down when nonsense words introduced; requires verbal praise cue. | [ ] Mild [ ] Moderate [ ] High |
8 Phonics Mastery Placement & Intervention Tier
Phase 1: Pre-Alphabetic
Needs support with basic rhyme, syllable clapping, or initial phoneme isolation (<60% accuracy).
Primary Target:
Phonological awareness drills, tactile letter sand-trays, oral sound blending.
Phase 2: Early Alphabetic
Mastered letter sounds; decodes CVC real words with tap-and-sweep; struggles with pseudo CVC or CVCe.
Primary Target:
CVC continuous blending, nonsense word fluency, short vs long vowel contrast.
Phase 3: Consolidated
Applies silent 'e' rule on real and nonsense words; ready for consonant blends, digraphs, and fluency speed.
Primary Target:
Sentence-level fluency phrasing, multisyllabic compound words, vowel teams.
9 Individualized Instructional Accommodations (Check all indicated)
Elkonin sound boxes with counters Slant board / pencil grip holder Visual reading window (single-line)
Extended wait time (minimum 8s) High-contrast font / yellow overlay Multisensory tap-and-slide cards
Frequent motor/sensory micro-breaks Reduced visual field (3 items/page) Paired auditory + tactile feedback
Qualitative Assessor Notes & Diagnostic Synthesis:
Record student self-talk, compensatory strategies, vowel confusions, or sensory behaviors observed...
Assessor Signature: __________________________________
Follow-up Intake Date: ________________
Phonics Intake Kit • Final Summary
Phonics Intake Student Booklet
Reading & Sound Check
Student Activity Booklet • Part 1
Let's Show What You Know!
1
Write Your Full Name
Use your best handwriting on the line below.
Start Here →
2
Say The Vowel Sounds
Point to each letter and tell your teacher the sounds it can make.
Aa
apple
Ee
egg
Ii
igloo
Oo
octopus
Uu
umbrella
Take your time! You are doing great.
Page 1 of 3
Student Activity Booklet • Part 2
Word Reading Practice
Look closely at each word
Real Words: Tap the dots and read
Read across →
cat
sip
mud
net
rot
Alien Words (Silly sounds! Make each sound)
Sound them out!
vag
pem
zib
kog
lup
Magic "e" Words (The vowel says its name!)
Long vowels
bake long /a/
ripe long /i/
robe long /o/
mule long /u/
Pete long /e/
Alien Magic "e" Words
Use the magic "e"!
vate /v-A-t/
jope /j-O-p/
kife /k-I-f/
mube /m-U-b/
sede /s-E-d/
Awesome reading! Let's read a short story next.
Page 2 of 3
Student Activity Booklet • Part 3
Fluency Reading Story
Read aloud with your best voice
Sam and the Pet Fox
Use your finger or tracker to follow each word
Track • Read • Smile
Sam has a red pet fox. The fox is fast.
The fox can hop on a big log in the mud.
Sam gave the pet fox a ripe bone.
The fox will hide the bone in a deep hole.
Sam smiled and waved as the fox ran home.
You Finished the Reading Check!
Great effort reading your words and sounds today!
Phonics Intake Booklet • Student Copy Page 3 of 3
Phonics Explorer Independent Packet
Quiet Independent Work
Phonics Detective Activity Packet
Name:
Date:
Activity 1: Short Vowel Detective
Say the name of the picture. Circle the correct middle vowel sound.
Picture: cat c __ t
a o u
Picture: bed b __ d
e i a
Picture: fish f __ sh
o i e
Picture: sun s __ n
u a o
Picture: box b __ x
e o u
Picture: cup c __ p
u a i
Bonus Vowel Color Key
Color each vowel star with your favorite crayon:
★ A = Red
★ E = Green
★ I = Blue
★ O = Orange
★ U = Purple
Good job! Turn the page for Sound Builders. Page 1 of 4
Activity 2
CVC Sound Box Builders
Write 1 sound per box
Sound Mapping Directions
Look at each picture. Say the 3 sounds slowly. Write each letter in its own box.
Picture: Hat 3 sounds: /h/ /a/ /t/
Picture: Pig 3 sounds: /p/ /i/ /g/
Picture: Mug 3 sounds: /m/ /u/ /g/
Picture: Pen 3 sounds: /p/ /e/ /n/
Helpful Letter Bank:
h a t p i g m u e n
Great writing! Turn to Page 3 for Magic E. Page 2 of 4
Activity 3
Magic "e" Transformers
Add 'e' to make the vowel say its name!
c a p short /a/
+ e →
c a p e long /a/!
Trace • Transform • Read
1
cap baseball cap
add e
superhero cape
2
pin safety pin
add e
pine tree
3
hop hop on one foot
add e
I hope so!
4
cub baby bear cub
add e
ice cube
Remember: The magic 'e' stays silent at the end, but it gives its power to the middle vowel!
Almost done! Turn to Page 4 for the Phonics Maze. Page 3 of 4
Activity 4
Phonics Word Path & Maze
Follow the real CVC words!
Path Finder Instructions
Start at START. Color or shade each box with a REAL word to help the puppy reach the bone!
START → bat
pob (silly)
vuj (silly)