Checklist

Name of the lesson:

Date:

Pre-Assessment/ Post Assessment Question:

Directions: Write down the students response to the question before the activity and after
the activity. Add any additional notes to the comment section.

Special Note: If the student was not there during the activity the box will be left blank or if
the student does not participate in the activity due to the other activities that were being
offered during that time the activity will be left blank.

Student Name: Pre-Assessment Post Assessment Comment:

Each letter represents the student

name. Students will not be shared for
privacy reasons.

A.

B.

C.

D.

E.

F.

G.

H.

I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
T.

Overall Notes of the activity: