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Assessment and Continuous Quality Improvement Form
Date
Names (who is reporting SII-PDCA)
Department/Office/Committee
Entity
CHSU
COP
COM
Unsure
Subject of Assessment Examples:
Course (number), Committee (name), Event (name), Process (name), Curriculum (program name), Initiative (name), Plan (name), Project (name), Performance / Presentation / Paper / Poster (name), Past SII-PDCA (name/date), Other (describe)
Instrument Used or Type of Data Collected Copy
Survey Results (End of course student survey results required for courses)
Focus Group Results
Formative student understanding within the course (e.g. Minute Paper, Muddiest Point, Student-Generated Test Questions, Classroom Opinion Polls)
Program outcome data (e.g., licensing examinations, PCOA, event attendance, scholarly productivity)
Input data (e.g., admission data, faculty/staff credentials on hire, student performance in prerequisite courses)
External review (e.g. accreditor visit
Tests/exam item analysis/student performance (required for courses)
Review of minutes or other ongoing record or reflection, e.g., “red book” for courses (name)
CLO/PLO/GLO rubrics and learning outcome data
Plan (e.g. strategic plan, earlier SII-PDCA forms, budgets, faculty adequacy model)
Peer review
Other
Assessment Name, Date, Who Was Assessed, Description of Assessments:
Strengths
And why are these strengths? How can you leverage these strengths?
Insights
What did you learn? What surprised you?
Areas for Improvement
What problems did you experience? What are the root causes of this problem? What are your assumptions?
Plan
What change is needed? What literature addresses this problem?
Do
What concrete steps will be taken? Is a pilot needed? Who will be impacted? Who needs to buy-in? Who should you communicate with? Who is responsible for doing what?
Check
What data will you collect and analyze to assess? Who will do the work? When will this be done? Adjust: Any changes implicated by assessment can be added to the original report or completed in a new SII-PDCA form
Additional Comments
Report must be conveyed to (Admin/ Faculty or Chair /Committee) Please specify:
Accreditation Standards related to Assessment Process Reviewed Above (to be added by DIAER)
ACPE
COCA
WSCUC
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