Common Formative Assessment Planning Template Page 2

SECTION 1: Assessment Design

Number of Questions Presented on Assessment: __________________________________________

Format of Assessment: check all that apply

_____ Multi-choice format

_____ Essay format

_____ Short Response format

_____ Experiment/Lab format

_____ Blended Response format

_____ Other ____________________________________________________________

Additional Materials Required:

Please list below any materials/resources students will need during the administration of the common

assessment. (For example, manipulatives, reference charts, measurement tables/formulas, etc.)

Potential Instructional Interventions Gained from Assessment:

List the potential instructional interventions that might be indicated through the administration of the

common assessment. (For example, small group lessons, etc.)

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