Impact on Student Learning Report

Please provide your Longwood ID: [Help]

NOTE: You MUST provide your correct Longwood ID in order for this form to be processed.

Please provide your name as you are currently enrolled at Longwood:

Last Name

First Name

Middle Name or Middle Initial

Please indicate on which of the following you are reporting information:

Please indicate the semester and year in which you are participating in this experience:

Semester

Year

INSTRUCTIONS FOR COMPLETING THE REST OF THIS REPORT: The information requested below should be based on the students and classroom where you taught. It is used by Longwood to ensure that its teacher preparation candidates can demonstrate their ability to impact P-12 student learning. Fill in the form as accurately as possible for each student in your class, leaving any boxes empty that are beyond the number of students you taught.

Impact on Student Learning Report	Pretest Score	Posttest Score
Points Possible
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Student 35

Please indicate your educational program of study:

Art Education

ESL

Science Education

Biology

History/Social Studies Education

Secondary Mathematics Education

Business Education

Library Media

Special Education

Chemistry

Middle School Education

Theatre Education

Elementary Education

Music

Other

English

Physical Education

Click "Finish" below to complete this form. If your electronic submission is successful, you will receive a summary of your responses. If this summary does not appear, please complete this form again.