Name: ________________________________                                                                            Date______________

1. Goals for 1-1 time:

__ work completion- unfinished work

__ additional understanding/ clarification

__revising

1. Why you need 1-1 time?

__ work completion- unfinished work

__ additional understanding/ clarification

__revising

1. What did you accomplish during 1-1 time?

__ work completion- unfinished work

__ additional understanding/ clarification

__revising

__nothing

                If you select nothing,  please explain why?

1. After 1-1 time, what do you still need to accomplish?

__ work completion- unfinished work

__ additional understanding/ clarification

__revising

__ all caught up

5. On a scale of 1-5, with 1 being no help and 5 being greatest improvement, how did the 1-1 time help you complete your goals?

1              2              3              4              5