Summary Forms

Teacher _________________________________________________ Grade ________ Year ___________________________

School _________________________________________________

Date _________________________________________________

Class Record Form

Benchmark Benchmark Benchmark
Student Name Independent Instructional Accur. Comp. Fluency Placement Notes
Level Level Level
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© 2011, 2008 by Irene C. Fountas and Gay Su Pinnell. Portsmouth, NH: Heinemann. This page may be photocopied.
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Fountas & Pinnell Benchmark Assessment System 1