Um, I'm not sure what you're looking for, but I've been told in the past to use FLAP+C formula.
F - Form (What form did you choose and why? Expository, creative, persuasive etc)
L - Language (What sort of language did you use? Formal, colloquial etc, and why?)
A - Audience (Who is your intended audience?)
P - Purpose (What are you trying to achieve through this piece? Why did you write it? Note: NOT to get an A+ on the exam!

)
+
C - Context (What is your context, how have you tackled it, etc)
And to refrain from having a boring ol' list, mention how each decision relates to the others. For example your target audience will influence the form, language you use etc, and your purpose will probably affect your audience.
Hope this helped!
Edit: oh, you wanted a sample.. sorry! Try the Examples Directory stickied on the English forum?