WSU Cooperative Extension  Life Skills Evaluation System - Measuring growth in life skills for youth and family programs  
 

SAMPLE EVALUATION FORM

  Why Evaluate?

The following is an example of the evaluation form that can be created using this system. This form includes 5 indicator statements taken from the indicator list found at View Life Skills.

SAMPLE
4-H Science Camp Evaluation

We want to know how well 4-H Science Camp works. We are asking you to answer the following questions about what you may have learned from being in 4-H Science Camp. It should take about 10 minutes of your time to complete the survey. You do not have to fill out this survey. If you decide not to fill out the survey, it will not affect your participation in future WSU Cooperative Extension programs. Your answers will be anonymous and will not be identified in any way. This means that no one will know how you have answered any of the questions. Answering the questions means you have agreed to participate in this evaluation. If you have any questions about this survey or the evaluation, please contact Helen Jones at (509) 555-1212.

Because of my participation in 4-H Science Camp I am able to:
 Back . . . before I
participated in 4-H Science Camp
Now . . . after I have participated in 4-H Science Camp
 
Circle one number
for each statement
Circle one number
for each statement
 

No

Sometimes
Usually
Yes

No

Sometimes
Usually
Yes
1. Wisely use the natural resources in my environment.  

 1
 

 2
 

 3
 

 4
 

 1
 

 2
 

 3
 

 4
 2. Listen carefully to what others say.  

 1
 

 2
 

 3
 

 4
 

 1
 

 2
 

 3
 

 4
 3. Treat people who are different from me with respect.  

 1
 

 2
 

 3
 

 4
 

 1
 

 2
 

 3
 

 4
 4. Work out problems that are presented to me.  

 1
 

 2
 

 3
 

 4
 

 1
 

 2
 

 3
 

 4
 5. Follow instructions as they are given me.  

 1
 

 2
 

 3
 

 4
 

 1
 

 2
 

 3
 

 4
 6. Follow instructions as they are given me.  

 1
 

 2
 

 3
 

 4
 

 1
 

 2
 

 3
 

 4

Tell us about yourself. (Check one response to each question).
 

1. My age falls in the  following group:

    ___11-13
    ___14-17
    ___18-25
    ___26-35
    ___36-45
    ___46-55
    ___55+

 

2. I am:

    ___female
    ___male

 

 

 

 3. My current home is:

     ___farm
     ___rural non-farm
     ___town under 50,000
     ___city over 50,000

 

 

4. I would describe myself as:

    ___African American
    ___American Indian
    ___Asian American
    ___Hispanic
    ___White/Caucasian
    ___Racially mixed

1. The most important thing I have gained from attending 4-H Science Camp is...

2. The one thing, if anything, I would change about 4-H Science Camp is...

3. Other comments I would like to make...


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WSU Learning Center
1300 5th St.
Wells Hall, Suite 1060
Wenatchee, WA 98801

Phone: 509.662.4730
Fax: 509.662.3368
Email: Life Skills Coordinator

Program Content Created By:
Mary Katherine Deen, Ext. Specialist
Sandra J. Bailey, Asst. Professor Louise Parker, Ext. Specialist

Computer Programing & Design:
Kathleen Duncan, Info. System Coord

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WebDesign By: Leila Styer - CAHE
Graphics By: Miro Vejzovic - CAHE