Student Name:

Grade Level:

Teacher:

Date:

Participation

4Consistently

3Usually

2Sometimes

1- Needs to
Improve

4Consistently

3Usually

2Sometimes

1- Needs to
Improve

4Consistently

3Usually

2Sometimes

1- Needs to
Improve

I ask questions

I participate in most
activities

Work Habits
I stay on task

I try my best even

when the work is hard

I am a good listener

I work well in groups.

Homework
My planner is neat and
up to date.

My planner is signed
by my mom or dad.

My homework is turned
in on time.

The Qingdao No. 1 International School of Shandong Province

Work Habits Self-Assessment Rubric

4Consistently

Overall Effort

3Usually

2Sometimes

1- Needs to
Improve

I am a kind and caring

student.

I follow the classroom

rules.

My Goals for Quarter 2

My Writing Goal
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My Reading Goal
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My Math Goal:
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Teacher Comment:
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