Sample Checklist for Assessment of Final
Complete/Incomplete Designation
Student Name Class Date
Use an “x” to indicate that the student has met expectations (complete). Samples have been provided
for Module A. To add other assessment tasks, tab and enter content. Fields are limited to
approximately 14 characters.
Module A: Module B: Module C: Module D: Module E:
Physical Activity Fitness Nutrition Personal and Healthy
Practicum Management Social Relationships
Development
GLO 1—Movement GLO 2—Fitness GLO 5—Healthy GLO 4—Personal and GLO 4—Personal and
GLO 2—Fitness Management Lifestyle Practices Social Management Social Management
Management GLO4—Personal and GLO 5—Healthy
GLO 3—Safety Social Management Lifestyle Practices
Physical Activity
Plan
Safety and Risk-
Management
Plan
Parent and
Student
Declaration
Forms
Physical Activity
Log and
Reflections
Student–
Teacher
Conferences
55 Hours of
Moderate to
Vigorous
Physical Activity
Achieved Achieved Student Achieved Achieved Achieved
Student Learning Student Student Student
Learning Outcomes Learning Learning Learning
Outcomes Outcomes Outcomes Outcomes
Final Assessment: Complete Incomplete