ice breaker

ICEBREAKER PLANNING SHEET

Student Name:

Student ID:

Name of the Icebreaker:

Brief description of the icebreaker:

Procedures and steps for the CYC/Facilitator (in numbered format) STEP BY STEP INSTRUCTIONS:

Describe and outline the teachable moments and questions for the CYC/Facilitator to ask:

Identify the goals of the Icebreaker for children/youth (What do you want your Icebreaker to accomplish? What is the purpose of your Icebreaker?) Identify at least 2 goals.

List of Materials (if any) required

Budget and rationale

Anticipated length of time and rationale

Identify the appropriate developmental age range for the Icebreaker. Briefly explain using knowledge and experience from Child Development.

Describe 1 modification you might make if the activity does not go as planned or if there are participants requiring modifications.

Reference, Resource or Web Link

ACTIVITY PLANNING SHEET

Student Name:

Student ID:

Name of the Activity/Type:

Brief description of the activity:

Procedures and steps for the CYC/Facilitator (in numbered format) STEP BY STEP INSTRUCTIONS:

Describe and outline the teachable moments and questions for the CYC/Facilitator to ask:

Identify the goals of the Icebreaker for children/youth (What do you want your activity to accomplish? What is the purpose of your activity?) Identify at least 2 goals.

List of Materials (if any) required

Budget and rationale

Anticipated length of time and rationale

Identify the appropriate developmental age range for the activity. Briefly explain using knowledge and experience from Child Development.

Describe 3 modifications you might make if the activity does not go as planned or if there are participants requiring modifications.

Reference, Resource or Web Link

Criteria

Exceeds Expectations

Meets Expectations

Approaching Expectations

Does not Meet Expectations

Activity Plan

All sections are completed (even if not applicable). The icebreaker is clearly outlined so that another CYC-P could facilitate it without any issues.

[8 points]

All sections are completed (even if not applicable). Another CYC-P could facilitate the icebreaker with few issues.

[5-7 points]

All sections are completed, but some areas are unclear and may be confusing to another CYC-P.

[3-4 points]

Some sections are missing and/or are confusing/hard to follow.

[0-2 points]

Spelling, Grammar and Formatting

Free of spelling, grammar, or formatting issues.

[2 points]

There are 1-2 spelling, grammar, or formatting issues.

[1 point]

There are more than 2 spelling, grammar, or formatting issues.

[0 points]

TOTAL

/10

Criteria

Exceeds Expectations

Meets Expectations

Approaching Expectations

Does not Meet Expectations

Activity Plan

All sections are completed (even if not applicable). The icebreaker is clearly outlined so that another CYC-P could facilitate it without any issues.

[12 points]

All sections are completed (even if not applicable). Another CYC-P could facilitate the icebreaker with few issues.

[8-11 points]

All sections are completed, but some areas are unclear and may be confusing to another CYC-P.

[5-7 points]

Some sections are missing and/or are confusing/hard to follow.

[0-4 points]

Spelling, Grammar and Formatting

Free of spelling, grammar, or formatting issues.

[3 points]

There are 1-2 spelling, grammar, or formatting issues.

[1-2 points]

There are more than 2 spelling, grammar, or formatting issues.

[0 points]

TOTAL

/15