Assessment of Student Learning Styles

Name of Student *

Discipline *

PT

OT

SLP

Date *

mm/dd/yyyy

I learn best when *

When performing a new task, I prefer to *

Select all that apply

For the next 5 responses, on a scale of 1 to 10, rate how each of the following contributes to your learning and retention of information.

Reading *

Hearing *

Seeing *

Feeling *

Active Participation *

When learning something new, I prefer to *

Select all that apply

I am most comfortable when I am given feedback *

*

Send me a copy of my responses

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