Instructor Name:
Course Number and Course Name:
Term:
This form is a tool to be completed prior to entering course assessment information into the
Access database. As you complete the course assessment process keep in mind, how can this
information improve student learning?
Directions for using the Course Assessment Form:
 If a line is available under the topic, click into it with the mouse. As you type, the table
will automatically adjust the row width. The bullet option may be selected if an outline
or list is desired. If you need the bullets to indent, select the “decrease indent” or the
“increase indent” located on the tool bar.
 If no blank line exists, click into the topic line and continue typing.
 Save periodically under a new file name.
 The Final Course Assessment Report should be filed with the appropriate
assessment consultant by November 1 (fall term) or April 1 (spring term). Each
faculty member will complete two course assessments per semester, which will include
the course assessment follow-up during the next semester, until all courses have been
assessed, and then the rotation will be repeated. If a course assessment reveals issues
requiring immediate attention, the faculty member should visit with the appropriate
division chair, discuss strategies for improved student learning, and then repeat the course
assessment after implementation.
Course Information
Course Number +Term+ Section ex.(BA1012008501)
Time of Section:
Course description
Division Name:
Students
 Number of students enrolled:
 Number of students completing:
 Number of student withdrawals:
Reasons (if known):
Number of A’s, B,s
Number of C’s
Number of D’s F’s
Summary Comments: (concerning student issues including class attendance and withdrawals that relate to
student success or failure)

Resources
Required student text and other required materials:

Additional instructor resources (ex. Other texts or books, Library, Internet resources, outside resources, etc.)

Check if you
use this
instructional
technique
Ex.
lecture
Ex.
Group work
Assigned reading
CATs
Class discussion
Daily assignment
Demonstration
Educational trip
Group work
Guest speakers
Hands-on exams
Instructor
conference
Internet activity
Internship/clinical
Lab
Lecture
Observation
Oral presentation
Panel discussion
Portfolio
PowerPoint
Pre and Post
Assessments
Quizzes
Role Playing
Simulation
Special project
Videos
Written exams
Other--explain


Check if Comments or discoveries regarding specific
you use
techniques
this
Assessment
technique

Student Learning Outcomes & Evaluation
Section 5: Evaluation Process
Student Learning
Outcomes (SLO)
for course.
Should have 7 or
less
What
primary
tool is
used to
assure
SLO
mastery?
# of
students
exceeding
expectations
# of
students
meeting
expectations
# of
What does your
students
evidence tell you about
failing to
this SLO?
meet
expectations
1. SLO
description
2. SLO
descipton
Recommended Changes in Instructional/Assessment methods
SLO1.
SLO3.
SLO5.
SLO2.
SLO4.
SLO6.
SLO 7.

Plan of Action to Improve Student Learning: (tie back to curriculum, instruction,
learning environment, learning resources, assessment process).
