Evaluation - English - Colin's Hope

Teacher's Name*
First Last
School Name*
School Zip code*
Student Name*
First Last
Date of Birth
MM slash DD slash YYYY
Is this a pre or post evaluation?*
Instructions: All text should be read aloud (or play the audio clip). Child then should select an answer (whether saying the number or pointing to the picture), and the evaluator can select the corresponding option and move to the next page.

Evaluator: Hi ! I'm going to ask a question and show you three pictures. Point to the picture you think is the best answer. Are you ready? Let's go!

Q1: This boy wants to go swimming. What should he do to stay safer?*
1 2 3
1. Go swimming by himself
2. Go swimming with his friend
3. Wait for a grown up to go swimming

Q2: This girl wants to learn how to swim. What should she do to stay safer?*
1 2 3
1) Have her friend teach her how to swim
2) Take swim lessons with a grown up
3) Teach herself to swim

Q3: This boy wants to go swimming. What should he wear to stay safer?*
1 2 3
1) A pool noodle
2) A life jacket
3) Arm floaties

Q4: This girl wants to go swimming. Who should watch her so she can stay safer?*
1 2 3
1) Her friend should watch her
2) A grown up should watch her
3) She can swim all by herself. No one needs to watch her.

Q5: This boy wants to go swimming. What should he do when he gets to the pool gate to stay safer?*
1 2 3
1) Go in to the gate by himself
2) Wait for his friend to go through the gate with him
3) Wait for a grown-up to go through the gate with him

Q6: This girl is swimming and sees the drain at the bottom of the pool. What should she do to stay safer?*
1 2 3
1) Stay at the top of the water away from the drain
2) Swim down to the drain and touch it with her hand
3) Swim down to the drain and sit on it

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