Content Area: ELA

Formative Assessment – Teacher Checklist

Learning Objective: After conducting a read-aloud and identifying the story elements as a class, students
will be able to recall the story elements as they complete multiple-choice exit slips.

Assessment Description: In this assessment, students will complete a four-question Google Form as an
exit slip. The questions will ask the students to recall the setting, characters, problem, and solution in the
book. The students will be given multiple-choice answers so that the slip can be done fairly quickly. After
the assessment, the teacher will use the checklist to grade the student's answers.

Google Form Link:

https://docs.google.com/forms/d/e/1FAIpQLSc4ZqX9kTGYmken8XFqKyCe4Vj9KSfjkQGPxJYz5InVfO1tAQ/
viewform?usp=sf_link

Modified Version Of Google Form Link:

https://docs.google.com/forms/d/e/
1FAIpQLSef26C6aRoJw9MdoZVWOBArAe4LhLLBE8IwR0CUxj6_wtOc1w/viewform?usp=sf_link

Rationale:

Scoring Guide Description: This checklist is made for the TC to utilize once the students have turned in
their exit slips. If the students answer a question correctly, they will get a mark in the box next to the
“YES” and receive 2 points. If the students answer a question incorrectly, then they will get a mark in the
“NO” and receive 0 points for that question. The TC will then add up the student's total points to get
their total out of 8 points.

Name: Total: /8

Feedback:

Did the student select the correct setting? YES NO /2pts

Did the student select the correct characters? YES NO /2pts
Did the student select the correct problem? YES NO /2pts
Did the student select the correct solution? YES NO /2pts

Differentiation: The scoring guide will not be differentiated, but the exit slip will be modified for student
one (IEP-learning disability), student two (ELL), and other students in the class like the two ELLs who are
struggling readers and writers (MTSS). The original version has four questions with four answers to
choose from, while the modified version has four questions with two answers to choose from, besides
question #2. This modification will serve to help these students digest less and defer between fewer
answers. The TC will pull this small group and read the questions and possible answers to the students
for all four questions. This will target all of these learners as they are struggling readers, and hearing the
TC will clarify the questions for them. This accommodation will additionally target student one (IEP
student) as the TC can redirect the student’s attention and keep them on task since she will be right in
front of the TC.