Evaluation:Form600____________________________________________________________

EvaluationbySiteSupervisor

Thisstudentperformanceevaluationtobecompletedbysitesupervisor:

StudentName:_______________________________Date:____________________________

PlacementSite:______________________________SiteSupervisor:____________________

EvaluationPeriod:___________________________#ofHoursWorked:_________________

CourseNameand#:_________________________InstructorName:____________________

A. Pleaseratetheservicelearnersperformanceinthefollowingareas:
(1Unsatisfactory,3Satisfactory,5Excellent.N/Aifnotapplicable)

1. FulfillmentofLearningPlanObjectives.12345N/A
2. Sensitivitytowardpeoplewithwhoms/heworked12345N/A
3. Responsibilityforregularattendanceandpunctuality..12345N/A
4. Qualityofperformanceofserviceactivities..12345N/A
5. Commitmenttocompletingtasks.12345N/A
6. Adaptabilitytochange(i.e.scheduling,agencyneeds,etc.).12345N/A
7. Respectforconfidentiality.12345N/A
8. Awarenessofroleinthecommunity.12345N/A
9. Enthusiasmforserviceactivities12345N/A
10. Benefitofserviceprovidedagency..12345N/A

B. Pleaseexplainanylessthansatisfactoryratings(i.e.ratingof1or2):
C. Pleasecommentonthestudentsgreateststrengthsandanyareasforimprovementthatmay
assistthecourseinstructorinevaluatingthestudentsabilitytoenter,participateinandexita
communityagencyresponsiblyandsensitively.
D. Isthereanythingthisservicelearnerdidthatwasparticularlycreativeornoteworthy?Feelfree
tocontinuecommentsontheothersideofform.

Pleasecompleteandreturnacopytothecourseinstructor.Thisevaluationwillbeconsideredin
assessingthestudentsperformanceinhis/heracademiccourse.
Ifyouhaveanyquestions,contactTheShastaCollegeCenterforCommunityEngagementat
SCCCE@shstacollege.eduor(530)2422337.Thankyou!

__________________________________ ______________________________

SignatureofSiteSupervisor Date