Sample Assessment Forms for Students
School Report Card
Original: 1930
To Parents:
We give two separate reports. The first indicates the progress made by the pupil
in the formation of the essential traits of good character and attitude of mind
that make for good citizenship. Upon these depend the future of democracy and
the stability of government. In this training we recognize that the school
shares responsibility with the home. The second report indicates the progress in
the regular grades. Superintendent, Los Angeles Unified School District
Citizenship
1. Obedience: Willingness to follow directions; respect for law and order.
2. Dependableness: Honesty, keeping of promises, promptness, loyalty,
willingness to cooperate, self-control.
3. Courtesy: Courtesy to associates and to teachers, respect for rights of
others; fair play; cheerfulness.
4. Cleanliness: Of person, clothes, behavior, speech.
5. Thrift: Respect for property, care of books, furniture and building, care
of own property, consideration for the property of others, recognition of the
value of time.
Conduct Grade for Report Card
(S= satisfactory; N= needs improvement)
___ Trustworthiness
___ Respectful
___ Responsible
___ Caring
Respectful
____ Completes homework ____ Uses appropriate language
____ Attends classes regularly ____ Uses appropriate voice tone
____ Follows directions ____ Offers to help others
____ Follows through on commitments ____ Uses good manners
Responsible
____ Caring
____ Turns in assignments
____ Offers friendship
____ Brings materials to class
____ Shows empathy
____ Does quality work
____ Comforts others
____ Does classroom chores
____ Shares resources
Planning and Assessment
Student Name:__________________________________________
Describe strategies you will use to demonstrate each of the following:
I will strive to be:
Respectful:
Responsible:
Hard working:
Cooperative:
Rate yourself today on each: (1=poor; 6=excellent) Include strategies for
improvement.
___ Respectful
___Responsible
___Hard working
___Cooperative
Parent rating: Comments
____Respectful
____Responsible
____Hard working
____Cooperative
The Week in Review
Student Name:_______________________ Date:__________
1. What was the high point of the week?
2. Whom did you get to know better?
3. What was the major thing you learned about yourself this week?
4. Did you institute any major changes in your life this week?
5. How could this week have been better?
6. Over what did you procrastinate this week?
7. Identify three decisions or choices you made this week. What were the results
of these choices?
a.
b.
c.
8. Did you make any plans this week for a future event?
9. What unfinished business do you have left?
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