NYSAA Data Collection Sheet for a Multi-Step TaskStudent Name: NOTE: A Data Collection Sheet cannot stand alone; supporting

evidence is required. Includes a minimum of three dates. Complete in full, including staff initials, for each date.

ACCURACY (Acc) KEY: (+) Correct Response (-) Inaccurate/No Response

Describe Steps of the Assessment Task (recommend at least 4):

Date Date Date Date Date Date Date Date

Acc+/-

Acc+/-

Acc+/-

Acc+/-

Acc+/-

Acc+/-

Acc+/-

Acc+/-

Teacher posed questions and recorded whether student responded appropriately…is it sunny today?…is it cold outside today?…should you wear a jacket?

…is it windy today?

Total +’s

Total Steps

Fraction / / / / / / / /Percent (%) % % % % % % % %

(REQUIRED FOR EACH DATE WITH DATA) Fill in Staff Initials of Person Recording the Data for Each Date

Staff Key (REQUIRED)Record the Initials and Corresponding Name of Staff Recording Data to Provide Key for Initials Recorded Above

Initials: _____ Name: ________________________ Initials: _____ Name: _____________________

Initials: _____ Name: ________________________ Initials: _____ Name: _____________________