IRCC PBLA Multilevel Module Pilot Feedback

Feedback form

After you have piloted the module, please complete this feedback form.

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* 1. Please fill out the information below.

Name:

e-mail:

CLB level(s) of your class:

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* 2. Which Module did you pilot? Choose one.

Police Services: Reporting a Stolen Item

Health: Going to a Walk-in Clinic

Tourism: Sharing Travel Experiences

Community and /or Education: Socializing with Friends

Banking: Reporting a Lost, Stolen or Damaged Card

Employment: Job Search

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* 3. Approximately how many class hours did you spend on the module (including the skill-building and skill-using activities to prepare learners for your assessment tasks)?

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* 4. Which assessment tasks did you use? Check all that apply.

Listening

Speaking

Reading

Writing

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* 5. Describe any modifications you made to the assessment tasks. Did you use one or more as skill-using activities rather than as assessment tasks?

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* 6. How many of the suggested lesson activities did you use? Choose one.

None

About 25 % of the activities

About 50% of the activities

About 70% of the activities

All

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* 7. Did you use additional lesson activities and resources? If so, please list them.

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* 8. How would you rate the usefulness of the materials, on a scale of 1 to 5?

	Not useful				Very useful
Module plan	Module plan Not useful	Module plan	Module plan	Module plan	Module plan Very useful
Assessment tasks	Assessment tasks Not useful	Assessment tasks	Assessment tasks	Assessment tasks	Assessment tasks Very useful
suggested activities	suggested activities Not useful	suggested activities	suggested activities	suggested activities	suggested activities Very useful

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* 9. What did you like best about the module package?

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* 10. Do you have any suggestions for improvements or additions to the module? Please comment on content (e.g. any content that should be added or deleted), or format (e.g. ease of use).

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* 1. Please fill out the information below.

Question Title

* 2. Which Module did you pilot? Choose one.

Question Title

* 3. Approximately how many class hours did you spend on the module (including the skill-building and skill-using activities to prepare learners for your assessment tasks)?

Question Title

* 4. Which assessment tasks did you use? Check all that apply.

Question Title

* 5. Describe any modifications you made to the assessment tasks. Did you use one or more as skill-using activities rather than as assessment tasks?

Question Title

* 6. How many of the suggested lesson activities did you use? Choose one.

Question Title

* 7. Did you use additional lesson activities and resources? If so, please list them.

Question Title

* 8. How would you rate the usefulness of the materials, on a scale of 1 to 5?

Question Title

* 9. What did you like best about the module package?

Question Title

* 10. Do you have any suggestions for improvements or additions to the module? Please comment on content (e.g. any content that should be added or deleted), or format (e.g. ease of use).

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* 11. Do you have any suggestions for module topics or materials that would be useful at this CLB level?