Form M1 - Mid-Term Member Evaluation printable pdf download

Form M1 - Mid-Term Member Evaluation

Mid-Term Member Evaluation (Form M1)

To be completed by site supervisor and shared with the member being evaluated.

2015-2016

Name of Member ____________________________ Placement Site ____________________

Period Covered by Evaluation: ____________________________________

Supervisor Completing Evaluation: _________________________________

Please evaluate the member using the following scale:

1 – Poor

2 – Fair

3 – Acceptable

4 – Good

5 – Excellent

1. Flexibility (e.g. ability to adjust to change)

2. Reliability

3. Professionalism

4. Ability to take initiative and complete assignments.

5. Ability to work with colleagues and clients

6. Ability to work with supervisors

8. Ability to work independently

9. Member is meeting performance goals established in

Community Work Plan

10. Demonstration of Leadership

11. Member is satisfactorily progressing toward

completing the required number of hours.

If you answered either poor or fair to any of the above items, please explain why in the

space provided below:

On the back of this sheet, explain the member’s greatest strengths, as well as anything that you

feel needs to be improved upon. Be as specific as possible. THANKS FOR YOUR HELP!

______________________

____________________________

Member Signature

Date

Site Supervisor Signature

Date

Return to: ISU, Center for Community Engagement, Tirey Hall 134, Terre Haute, IN 47809

Form M1 - Mid-Term Member Evaluation