PULSE Student Evaluation Form

Evaluation Forms

PULSE Evaluation - 1st Semester

Student's Name ___________________________________________________
Supervisor _______________________________________________________
Placement ________________________________________________________

I: TERMS OF THE AGREEMENT Evaluation of the student's adherence to the terms outlined in Section II of the Learning-Work Agreement.
Tasks: Has the student performed the tasks outlined in the Learning-Work Agreement? Please comment on the level of skill the student has exhibited or attained in the completion of these tasks. Has the student shown progress?

PULSE students are expected to show interest in, enthusiasm for, and commitment to the work of their placement and to attempt to learn about the issues at hand. Please comment on the student's attitude, approach to the work, and willingness to engage in the life of the agency.

Faithfulness to Schedule/Attendance: Has the student been faithful to the schedule which was outlined in the Learning-Work Agreement?

How many scheduled days did the student miss? (Please include dates of absences if possible.) Did student follow established absentee policy, i.e. called to say they would not be in, produced doctor's note? Were the missed days made up?

II: LEARNING GOALS Discussion of progress made towards achievement of learning goals as stated in Section I of the Learning-Work Agreement.
How far do you think the student has come in reaching their learning goals over the course of the semester?

Has the student met your stated expectations? In general, has this student been responsible to his/her commitment to your agency?

III: SUMMARY ASSESSMENT Please check the category which most accurately describes the student's service to your agency this semester and circle the appropriate grade. In the box below, please be specific about what led to that grade.

_____Student has exceeded expectations. A Has exceeded the expectations outlined in the Learning-Work Agreement. Exceptional. Has gone above and beyond. Has undertaken original and creative ventures while at placement or has given of him/herself in a special way to the agency.

_____Student has met all expectations. Circle one: A- B+ B Adherence to the terms outlined in the Learning-Work Agreement. Performance of duties in a skillful, efficient and careful manner. Evidence of effort and progress toward Learning Goals stated in Learning-Work Agreement.

_____Student has met most expectations. Circle one: B- C+ C While the student has met most expectations outlined in Learning-Work Agreement, improvement is required in one or more area, for example, performance of tasks, approach to duties, attendance and faithfulness to schedule, interpersonal relations with clients or staff.

_____Student has not met most expectations. Circle one: C- D+ D D- Although the student has not been harmful to the work of the agency, he or she has not contributed in a meaningful way to that work. The student's work has been characterized by incomplete or haphazard performance of duties, absence of initiative, poor attendance, lack of good judgment, or other behaviors.

_____Student has failed to maintain commitment to agency. F The student has exhibited one or more of the following: Flagrant non-adherence to the Learning-Work Agreement Excessive absence Serious violation of agency policy Poor relations with staff or clients of agency Inappropriate behavior or poor judgment Disregard for the dignity or the safety of the clients of the agency

Explanation:

Signature of Supervisor: ________________________ Date: _____________

IV: SELF ASSESSMENT To be filled out by the student.
In the Learning-Work Agreement, you stated what you hoped to learn from your placement. How far do you think you have come?

Were your goals reasonable? After a semester at your placement, how would you revise these goals?

Have you received sufficient guidance from your supervisor? If you feel that more guidance is necessary, what do you suggest?

Please respond to your supervisor's evaluation of your work this semester.

Signature of Student: ________________________ Date: _____________

PULSE Evaluation - 2nd Semester

PULSE students are expected to show interest in, enthusiasm for, and commitment to the work of their placement and to attempt to learn about the issues at hand. Please comment on the studentÕs attitude, approach to the work, and willingness to engage in the life of the agency.

Faithfulness to Schedule/Attendance: Has the student been faithful to the schedule which was outlined in the Learning-Work Agreement?

Has the student met your stated expectations? In general, has this student been responsible to his/her commitment to your agency?

_____Student has not met most expectations. Circle one: C- D+ D D- Although the student has not been harmful to the work of the agency, he or she has not contributed in a meaningful way to that work. The studentÕs work has been characterized by incomplete or haphazard performance of duties, absence of initiative, poor attendance, lack of good judgment, or other behaviors.

Explanation:

Signature of Supervisor: ________________________ Date: _____________

IV: SELF ASSESSMENT To be filled out by the student. How far do you think you have come in achieving your learning goals at your placement this year? Please comment on your year in PULSE.

Please respond to your supervisor's evaluation of your work this semester.

Signature of Student: ________________________ Date: _____________

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