Exit Slip Formative Assessment Questionnaire Form
Please complete the Exit Slip Formative Assessment Questionnaire Form to reflect on your learning and provide feedback.
Full Name
*
First Name
Last Name
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How well did you understand today's lesson?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
How engaged did you feel during the lesson?
*
1
2
3
4
5
What is your main takeaway from today's lesson?
*
A new skill or concept
A better understanding of a topic
A question that needs answering
Other
Self-assessment of today's learning objectives
*
Rows
Not Yet
Somewhat
Mostly
Fully
I can explain the main idea
1
2
3
4
I can apply the concept
5
6
7
8
I can give an example
9
10
11
12
What is something you learned today?
*
Is there anything you are still unsure about?
*
What feedback do you have for the lesson or instructor?
What is your next step or action based on today's lesson?
Submit
Should be Empty: