Community Partner Evaluation of Student

Community Partner Information

Community Partner Supervisor Name *

Community Agency/Program *

Email *

Student Information

Student First Name *

Student Last Name *

Semester *

Fall

Spring

Summer

Year *

Student Course Associated with Placement

Ex. CBL 100: Introduction to Community Based Learning

Total Hours (student has completed to date) *

Evaluate Student

Please evaluate the CBL student *

	poor	average	good	excellent	N/A
Reliability: Did the student arrive on time and stay entire time on scheduled visit days? *	Reliability: Did the student arrive on time and stay entire time on scheduled visit days? - poor	Reliability: Did the student arrive on time and stay entire time on scheduled visit days? - average	Reliability: Did the student arrive on time and stay entire time on scheduled visit days? - good	Reliability: Did the student arrive on time and stay entire time on scheduled visit days? - excellent	Reliability: Did the student arrive on time and stay entire time on scheduled visit days? - N/A
Ability of student to notify you in advance if he/she could not attend placement and schedule a time to make up hours? *	Ability of student to notify you in advance if he/she could not attend placement and schedule a time to make up hours? - poor	Ability of student to notify you in advance if he/she could not attend placement and schedule a time to make up hours? - average	Ability of student to notify you in advance if he/she could not attend placement and schedule a time to make up hours? - good	Ability of student to notify you in advance if he/she could not attend placement and schedule a time to make up hours? - excellent	Ability of student to notify you in advance if he/she could not attend placement and schedule a time to make up hours? - N/A
Ability of student to adapt to the agency environment *	Ability of student to adapt to the agency environment - poor	Ability of student to adapt to the agency environment - average	Ability of student to adapt to the agency environment - good	Ability of student to adapt to the agency environment - excellent	Ability of student to adapt to the agency environment - N/A
Ability of student to be resourceful *	Ability of student to be resourceful - poor	Ability of student to be resourceful - average	Ability of student to be resourceful - good	Ability of student to be resourceful - excellent	Ability of student to be resourceful - N/A
Willingness to take initiative *	Willingness to take initiative - poor	Willingness to take initiative - average	Willingness to take initiative - good	Willingness to take initiative - excellent	Willingness to take initiative - N/A
Ability of the student to follow directions/instructions *	Ability of the student to follow directions/instructions - poor	Ability of the student to follow directions/instructions - average	Ability of the student to follow directions/instructions - good	Ability of the student to follow directions/instructions - excellent	Ability of the student to follow directions/instructions - N/A
Ability of the student to demonstrate patience *	Ability of the student to demonstrate patience - poor	Ability of the student to demonstrate patience - average	Ability of the student to demonstrate patience - good	Ability of the student to demonstrate patience - excellent	Ability of the student to demonstrate patience - N/A
Ability to cooperate with peers, support staff and clients/guests *	Ability to cooperate with peers, support staff and clients/guests - poor	Ability to cooperate with peers, support staff and clients/guests - average	Ability to cooperate with peers, support staff and clients/guests - good	Ability to cooperate with peers, support staff and clients/guests - excellent	Ability to cooperate with peers, support staff and clients/guests - N/A
Ability to accept and utilize criticism *	Ability to accept and utilize criticism - poor	Ability to accept and utilize criticism - average	Ability to accept and utilize criticism - good	Ability to accept and utilize criticism - excellent	Ability to accept and utilize criticism - N/A
OVERALL performance of the student at the agency *	OVERALL performance of the student at the agency - poor	OVERALL performance of the student at the agency - average	OVERALL performance of the student at the agency - good	OVERALL performance of the student at the agency - excellent	OVERALL performance of the student at the agency - N/A
OVERALL attitude of the student *	OVERALL attitude of the student - poor	OVERALL attitude of the student - average	OVERALL attitude of the student - good	OVERALL attitude of the student - excellent	OVERALL attitude of the student - N/A

What specific projects/tasks were completed by the student during his/her placement with your agency?

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