WV1 Pre-Assessment Character Development- Afterschool Program

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September 2021

Student Name

Student Grade

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Clear selection

Does PLAYING music change the way you feel (your emotions?)

Yes

I don't really know

Sometimes

Clear selection

Does PLAYING music bring you good feelings (happiness, peace, joy?)

Yes

I don't really know

Sometimes

Clear selection

Does LISTENING to music change the way you feel?

Yes

Sometimes

I don't really know

Clear selection

Does listening to music bring you good feelings? (happiness, peace or joy?)

Yes

Sometimes

I don't really know

Clear selection

Are you a musician?

Yes

I don't know

Sometimes

Clear selection

Do you have friends in Sistema? How many?

2-3 (a couple)

4-5 (a few)

5+ (many)

Clear selection

I get my homework done each night.

Yes

Sometimes

Clear selection

I have learned about these Builder themes this year in Sistema:

I am a Builder when I Build with Enthusiasm

I am a Builder when I am Perfectly Honest

I am a Builder when I Express Gratitude in Word and Deed

I am a Builder when I look for ways to serve others (Kigatsuku)

I am a Builder when I Work Diligently

I am a Builder when I Befriend Others

I am a Builder when I'm willing to try and believe in my ability to Succeed

I am a Builder when I use Kind and Courteous Words

I am a Builder when I am Utterly Reliable

I have not learned about any of these builder themes this year in Sistema.

Questions about applying Builder themes: I Build with Enthusiasm

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I am Perfectly Honest

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I Express Gratitude in Word and Deed

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I look for ways to serve others (Kigatsuku)

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I Work Diligently

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I Befriend Others

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I'm willing to try and believe in my ability to Succeed

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I use Kind and Courteous Words

Always

Usually

Sometimes

Not really

Clear selection

Questions about applying Builder themes: I am Utterly Reliable

Always

Usually

Sometimes

Not really

Clear selection

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