In my travels across the interwebs, I have found serval worksheets that ask students to refer back to the text. They always come with texts at the top, but I often find that they are too hard or too easy fro my kiddos, so I designed this one.
You can fill in the text and the questions, while sticking with a familiar template. This would make a great center or a quick formative assessment.
Border from Ink-N-Little Things (http://www.teacherspayteachers.com/Store/Ink-N-Little-Things). Fonts used: Return to Sender, Pea Celestial