Form Approved
OMB No. 0920-XXXX
Exp. Date:
Public
reporting burden of this collection
of information is estimated to average 15
minutes
per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required
to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to
CDC/ATSDR Information Collection Review Office, 1600 Clifton Road
NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).
Attachment JJ:
Student Program Fidelity 8th Grade Session 3 (Comprehensive)
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Student Curriculum – 8th Grade, Session 3 – Why Do People Abuse
Attendance Log
Implementer Name: _________________________ Implementer ID: ___________________
School ID: ____________________________ Session ID: _________________
Classroom ID:_____________________________ Program Year: ____________________
Please have each student sign initials next to their name to indicate attendance to the session
Student Names (Pre-Typed) |
Student ID (pre-typed) |
Student Initials for Present |
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S tudent Curriculum – 8th Grade, Session 3 - Why Do People Abuse
Implementer Name: _____________________ Implementer ID: ___________________
School ID: ____________________________ Session ID: _________________
Classroom ID:__________________________
Program Year: ____________________ Time lesson began: ___________
Date: __________________________ Time lesson ended: ___________
Please indicate if you completed the following activities:
Activity |
Yes |
Yes w/ changes |
No |
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dependent on them |
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may abuse |
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being a victim or abuser |
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q |
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Describe any changes you made to the session activities (please identify which activity you are describing by number).
Please indicate if you experienced any of these challenges that interfered with implementing today’s session. Check all that apply.
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Please check the extent to which the students were engaged in today’s lesson on the following measures:
Most students… |
Strongly Agree |
Agree |
Don’t Know |
Disagree |
Strongly Disagree |
Asked relevant questions. |
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Suggested solutions to scenario problems. |
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Responded correctly to questions. |
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Distracted other students. |
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Participated extensively in discussions. |
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Discouraged other students from participating. |
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Please think about today’s session and tell us your answers to the following questions. Circle the number that shows your opinion about each question.
How well do you think the students understood the session material?
1 Not at all
2 A little
3 A lot
4 Completely
How well did the session material fit into the allotted time period?
1 Session was too packed/not enough time to complete all activities
2 Session was somewhat packed/able to complete most but not all
3 Session was just right
4 Not enough material/session ended before class period completed
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Wendy LiKamWa |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |