Executive Function Skills Assessment Platform

Evaluator Information

Evaluator Name *

Evaluator Title/Role *

Student/Client Name *

Date of Assessment *

Age/Grade Level

Organization/School

Assessment Purpose

Additional Notes

Attention Skills Assessment

Rate each statement based on the student's typical behavior. Code: ATT-XX

ATT-01

I can easily complete tasks with lots of steps.

Never Rarely Sometimes Often Always

ATT-02

I work carefully and avoid rushing through tasks.

Never Rarely Sometimes Often Always

ATT-03

I can power through a task even if it's boring.

Never Rarely Sometimes Often Always

ATT-04

If I get interrupted in the middle of a task, I can easily pick up where I left off.

Never Rarely Sometimes Often Always

ATT-05

Once I start on a task, I can work straight through to the end.

Never Rarely Sometimes Often Always

ATT-06

I focus on homework and chores without getting sidetracked.

Never Rarely Sometimes Often Always

ATT-07

I can focus on my work even when others are talking around me.

Never Rarely Sometimes Often Always

Organization Skills Assessment

Rate each statement based on the student's typical behavior. Code: ORG-XX

ORG-01

I like my spaces neat and orderly.

Never Rarely Sometimes Often Always

ORG-02

I have systems to organize my work.

Never Rarely Sometimes Often Always

ORG-03

I know what I need to do, and when I need to do it.

Never Rarely Sometimes Often Always

ORG-04

When I have a lot to do, I can make a plan and figure out what I need to do first.

Never Rarely Sometimes Often Always

ORG-05

I feel better when my space is organized.

Never Rarely Sometimes Often Always

ORG-06

People who know me say that I am an organized person.

Never Rarely Sometimes Often Always

ORG-07

I try to have a place for everything.

Never Rarely Sometimes Often Always

Planning Skills Assessment

Rate each statement based on the student's typical behavior. Code: PLN-XX

PLN-01

I know which task to start first when I begin a project.

Never Rarely Sometimes Often Always

PLN-02

I like to have a plan so I don't feel overwhelmed.

Never Rarely Sometimes Often Always

PLN-03

I use a calendar or a tool to remind me of events.

Never Rarely Sometimes Often Always

PLN-04

I get tasks done neatly and orderly.

Never Rarely Sometimes Often Always

PLN-05

I stick to a daily routine.

Never Rarely Sometimes Often Always

PLN-06

When I start chores or homework, I finish them through to the end.

Never Rarely Sometimes Often Always

PLN-07

I know how to put steps in order for a bigger project.

Never Rarely Sometimes Often Always

Self-Regulation Skills Assessment

Rate each statement based on the student's typical behavior. Code: SR-XX

SR-01

When bad things happen, I bounce back easily.

Never Rarely Sometimes Often Always

SR-02

Others say I have good patience.

Never Rarely Sometimes Often Always

SR-03

I handle frustration in healthy ways.

Never Rarely Sometimes Often Always

SR-04

I avoid saying things to 'get back' or hurt someone when I'm upset.

Never Rarely Sometimes Often Always

SR-05

When I get upset, it's easy for me to calm down and get back to work.

Never Rarely Sometimes Often Always

SR-06

I control my temper.

Never Rarely Sometimes Often Always

SR-07

I have a high tolerance for frustration. I can work through difficult things.

Never Rarely Sometimes Often Always

Task Initiation Skills Assessment

Rate each statement based on the student's typical behavior. Code: TI-XX

TI-01

Procrastination is usually not a problem for me.

Never Rarely Sometimes Often Always

TI-02

I know how to get started with most tasks.

Never Rarely Sometimes Often Always

TI-03

I like to start chores and homework right away.

Never Rarely Sometimes Often Always

TI-04

I can complete daily tasks without reminders from parents or teachers.

Never Rarely Sometimes Often Always

TI-05

I easily finish tasks, even ones I don't want to do.

Never Rarely Sometimes Often Always

TI-06

I can set aside a fun activity when I have something more important to complete first.

Never Rarely Sometimes Often Always

TI-07

I know how to choose the most important task.

Never Rarely Sometimes Often Always

Working Memory Skills Assessment

Rate each statement based on the student's typical behavior. Code: WM-XX

WM-01

I pay close attention to details to avoid mistakes.

Never Rarely Sometimes Often Always

WM-02

Others say I have a good attention span.

Never Rarely Sometimes Often Always

WM-03

I can remember multiple instructions for tasks.

Never Rarely Sometimes Often Always

WM-04

I don't often forget what I'm doing or get lost in the middle of a task.

Never Rarely Sometimes Often Always

WM-05

I can see chores, homework, and tasks through to the end.

Never Rarely Sometimes Often Always

WM-06

I have strong reading and math skills.

Never Rarely Sometimes Often Always

WM-07

I can keep track of lots of facts and information and recall them when I need it.

Never Rarely Sometimes Often Always

Assessment Results & Summary

Executive Function Skills Scores

EF Domain	Code	Score	Status	Interpretation