Teacher Survey for Alaska 21st Century Community Learning Centers (21st CCLCs) This survey is designed to collect information about changes in a behavior during the school year. particular student’s Please select only one response for each of the questions asked in the table below to indicate the extent to which the student did or did not improve on that behavior during the course of the school year. Name of Student: ___________________________________ School: ___________________________________________ Grade: ____ Please answer the questions below to indicate changes in the habits from early in the school year to the spring. student’s To what extent has your Significant Slight No Slight Significant student changed in terms of: Improvement Improvement Change Decline Decline ▢ ▢ ▢ ▢ ▢ Completing homework Participating in class ▢ ▢ ▢ ▢ ▢ (e.g., engaged and attentive) ▢ ▢ ▢ ▢ ▢ Behaving well in class Working collaboratively with ▢ ▢ ▢ ▢ ▢ peers ▢ ▢ ▢ ▢ ▢ Academic performance Seeking assistance when ▢ ▢ ▢ ▢ ▢ appropriate ▢ ▢ ▢ ▢ ▢ Persevering through challenges Expressing needs and feelings ▢ ▢ ▢ ▢ ▢ appropriately Getting along well with other ▢ ▢ ▢ ▢ ▢ students Forming positive relationships ▢ ▢ ▢ ▢ ▢ with adults Please answer the question below to indicate changes in the habits from early in the school year to student’s family’s the spring. To what extent has your Significant Slight No Slight Significant changed in student’s family Improvement Improvement Change Decline Decline terms of: Engaging in their child’s ▢ ▢ ▢ ▢ ▢ education If you would like, please add any additional comments or observations you may have:
Teacher Survey for Alaska 21st Century Community Learning Centers (21st CCLCs) This survey is designed to collect information about changes in a particular student’s behavior during the school year. Please select only one response for each of the questions asked in the table below to indicate the extent to which the student did or did not improve on that behavior during the course of the school year. Name of Student: ___________________________________ School: ___________________________________________ Grade: ____ Please answer the questions below to indicate changes in the student’s habits from early in the school year to the spring. To what extent has your student changed in terms of: Significant Improvement Slight Improvement No Change Slight Decline Significant Decline Completing homework ▢ ▢ ▢ ▢ ▢ Participating in class (e.g., engaged and attentive) ▢ ▢ ▢ ▢ ▢ Behaving well in class ▢ ▢ ▢ ▢ ▢ Working collaboratively with peers ▢ ▢ ▢ ▢ ▢ Academic performance ▢ ▢ ▢ ▢ ▢ Seeking assistance when appropriate ▢ ▢ ▢ ▢ ▢ Persevering through challenges ▢ ▢ ▢ ▢ ▢ Expressing needs and feelings appropriately ▢ ▢ ▢ ▢ ▢ Getting along well with other students ▢ ▢ ▢ ▢ ▢ Forming positive relationships with adults ▢ ▢ ▢ ▢ ▢ Please answer the question below to indicate changes in the student’s family’s habits from early in the school year to the spring. To what extent has your student’s family changed in terms of: Significant Improvement Slight Improvement No Change Slight Decline Significant Decline Engaging in their child’s education ▢ ▢ ▢ ▢ ▢ If you would like, please add any additional comments or observations you may have:
Evaluation_Technical_Assistance.docx