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Academic Motivation Tracking Form (3 pages)
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HANDOUT 3
Academic Motivation Tracking Form
Name ______________________________________________ Date ________________________
1. Using the effort thermometer below, place an X on the spot that best indicates
your overall effort for today.
|
0
|
10
|
20
|
30
|
40
|
50
|
60
2. Did you have trouble today trying your hardest?
|
70
|
80
oYes o No
|
|
90
100
If you answered yes, complete questions a–g. If you answered no, go on to
question 3.
a. What type of schoolwork were you doing when you had trouble trying
your hardest?
o Class work
o Getting extra help
o Taking a test
o Homework
Other _____________________________________________________________________
b. What was going on at that time:
o Somebody teased me.
o I couldn’t do the work.
o I got embarrassed.
o The teacher criticized me.
o I felt everyone was watching how I did.
o I did something wrong.
o I got confused.
o Other __________________________________________________________________
c. What did you feel?
Sad
Scared
Mad
Happy
Frustrated
(page 1 of 3)
Not at all
0
0
0
0
0
A little bit
1
1
1
1
1
A lot
2
2
2
2
2
From Enhancing Academic Motivation: An Intervention Program for Young Adolescents.
Copyright © 2006 by Norman Brier. Research Press (800-519-2707; www.researchpress.com)
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d. What did you think?
o I was stupid.
o I can do this.
o The work was stupid.
o I am going to try.
o I hate school.
o Other __________________________________________________________________
e. What did you do?
o Tried
o Walked out
o Acted silly
o Got sad
o Asked for help
o Got mad
o Gave up
o Other __________________________________________________________________
f. How do you think you handled this situation?
1
Poorly
2
Not so well
3
OK
g. What could you do differently next time?
4
Well
5
Great
o Try harder
o Ask for help
o Ask permission to leave and come back when feeling better
o Other __________________________________________________________________
3. Did you try to do schoolwork today even if you were scared that you would not
do OK?
o Yes
o No
o Didn’t come up
o Yes
o No
o Didn’t come up
o Yes
o No
o Didn’t come up
4. Did you judge how you did today according to how much progress you made?
5. Did you ask for help today if you were stuck?
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Handout 3 (page 3 of 3)
Homework
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