\documentclass[11pt]{article}
  \usepackage{latexsym,geometry}

  \newcommand{\yn}{$\Box$ yes / $\Box$ no}
    \newlength{\ynlen}
    \settowidth{\ynlen}{\yn}
  \newcommand{\fillin}{\rule{\ynlen}{\s}}
  \newcommand{\ShortAnswer} {\underline{\hspace{1cm}}\ }
  \newcommand{\checkbox}[1] {$\Box$~{#1}\hfill}
  \newcommand{\s}{0.12mm}


\begin{document}
   \begin{flushright}
   \end{flushright}
   \begin{center}
   {\bf\Large Student Assessment of Test}\\\medskip
     \begin{tabular}{ll}
       Which test: \underline{\hspace{3cm}}
       & Course \& Time: \underline{\hspace{3cm}}
     \end{tabular}
   \end{center}

   \section*{Part A}
   \begin{enumerate}
     \item Did the content you expected to see appear on this test?
           \dotfill \yn
     \item Did you understand what the questions were asking?
           \dotfill \yn
     \item List the numbers of the questions you were unclear about:
           \dotfill \fillin
     \item Are you satisfied with your responses to most of the test
           questions?
           \dotfill \yn
     \item List the number(s) of the question(s) that you weren't
           satisfied with your answers to:\\
           \ldots\dotfill \fillin
   \end{enumerate}

   \section*{Part B}
     Assign a percentage grade on the line after each of the following
   statements.
     The grade should reflect how well you believe the test
   accomplished each objective.

   \begin{enumerate}
     \item Test corresponded to textbook content
           \dotfill \fillin\%

     \item Test corresponded to class lectures
           \dotfill \fillin\%

     \item Test related to discussion in class
           \dotfill \fillin\%

     \item Test challenged you to think creatively
           \dotfill \fillin\%

     \item Test included concepts studied in homework
           \dotfill \fillin\%

     \item Test motivated you to question ideas you previously took for granted
           \dotfill \fillin\%
   \end{enumerate}

   \section*{Part C}
   \begin{enumerate}

     \item Grade the test --- assign it a letter grade based on its
           form, content, and fairness:
           \dotfill \fillin

     \item What grade do you think you earned on the test?
           \dotfill \fillin
   \end{enumerate}

   \begin{flushright} Continues on other side \ldots\end{flushright}
   \newpage

   \section*{Part D}
    
   \begin{enumerate}
     \item Which part of the test most challenged your thinking?  Explain why.
           \\\vspace{\fill}

     \item Which part of the test least challenged your thinking? Explain why.
           \\\vspace{\fill}

     \item If you were to take this test again with only one section
           remaining the same, which section would you want that to
           be?  Explain why.
           \\\vspace{\fill}

     \item If you were to take this test again and only one section
           could be changed, which section would you choose?  Explain why.
           \\\vspace{\fill}
   \end{enumerate}


   {\tiny \noindent
     Instrument adapted from Figure~1 of `Examinations: Accentuating
     the Positive' by McMullen-Pastrick and Gleason in {\it Teaching
     College: Collected Readings for the New Instructor} Neff and
     Weimer (ed.), Magna Publications, Inc. (1990).
   }
\end{document}
