Wisconsin Reads

Family History Survey


Wis. Stat. §118.016 part of 2023 Wisconsin Act 20 (Act 20) requires local education agencies (LEAs) to conduct “diagnostic assessments” to any student in 5K through grade 3 who obtains a score below the 25th percentile on the reading readiness screener. As part of the diagnostic assessment, LEAs must include a “family history survey,” defined as “a questionnaire that includes questions about previous recommendations for summer reading support or outside tutoring, general interest in reading and books, family history of characteristics of dyslexia, and any known family struggles in reading or spelling” (118.016(1)(d)). LEAs must provide the family history survey; parents/caregivers are not required to respond.

Under Wis. Stat. §118.016, LEAs can determine how they wish to conduct a family history survey as part of the diagnostic assessment.  There are multiple ways that LEAs can meet this legal requirement.  This resource is being provided to assist LEAs in determining how to conduct the family history survey efficiently and in a manner that provides the vital information that only parent(s) or caregivers(s) possess.  While screening and diagnostic assessment data are important, parent/caregiver input is critical to best support our young learners struggling to develop adequate literacy skills.

DPI's Family History Survey: Sample and Guidance, includes:

  • options for administering the family history survey
  • considerations for choosing how and when to administer the family history survey
  • considerations for meaningful family engagement
  • a sample family history survey

Sample Family History Survey

This sample survey includes only questions required by Wis. Stat. §118.016. An LEA can add questions, including opportunities for the parents/caregivers to describe a child’s strengths and interests, as well as ways their family or community uses literacy.

The sample survey is available in English, Arabic, Burmese, Chinese, Hmong, Karen, Somali, and Spanish. All translations can be downloaded here and are found at the end of the document linked above.

Sample Family History Survey in English
Sample Family History Survey in Arabic
Sample Family History Survey in Burmese
Sample Family History Survey in Chinese
Sample Family History Survey in Hmong
Sample Family History Survey in Karen
Sample Family History Survey in Somali
Sample Family History Survey in Spanish