SAMPLE
Cooperative Education—Student Evaluation Form
(This form is to be filled out by the Supervisor of the Student/Employee)

_______________________________________________	________________________________________
Print Supervisor Name				Title

___________________________________________________________________________________________________
Place of Employment	Address

_______________________________________________	________________________________________
Student Name 					Student Job Title
**Attach one check stub for pay period to this time card for official audit**

RATE STUDENT/EMPLOYEE USING THE FOLLOWING SCALE:
5 -Excellent; 4 -Above Average; 3.5 -Meets Expectations; 3 -Average; 2 -Below Average; 1 -Poor

Part I - Employability______________________________________________________________
1.  Uses correct language; speaks clearly; listens			5    4    3.5    3    2    1    N/A
2.   Works well with others; is a part of the team; uses initiative	   	5    4    3.5    3    2    1    N/A
3.   Punctual to work; has good attendance; uses good judgment    	5    4    3.5    3    2    1    N/A
4.   Accepts responsibility; is reliable; follows up on job assignments	5    4    3.5    3    2    1    N/A
5.   Greets clients; is respectful; is courteous; has acceptable attitude	5    4    3.5    3    2    1    N/A
Part II - Specific Job Skills and Work-site Requirements________________________________
6.   Follows prescribed dress code and/or uniform requirements	5    4    3.5    3    2    1    N/A
7.   Performs duties and job assignments without being reminded	5    4    3.5    3    2    1    N/A
8.   Performs specific tasks efficiently and effectively			5    4    3.5    3    2    1    N/A
9.   Follows directions from manager and/or supervisor/team leader	5    4    3.5    3    2    1    N/A
10. Follows safety, security and/or sanitation policies			5    4    3.5    3    2    1    N/A
11. Performs duties in timely fashion without reminders		5    4    3.5    3    2    1    N/A
12. Shows job competence and task improvement since hiring		5    4    3.5    3    2    1    N/A
Part III – Professional Growth/Ethics________________________________________________
13. Demonstrates knowledge of company/unit policies/functions	5    4    3.5    3    2    1    N/A
14. Shows loyalty to and has knowledge of mission statement		5    4    3.5    3    2    1    N/A
15. Attends meetings when directed; follows company policies/goals	5    4    3.5    3    2    1    N/A
16. Demonstrates legal and ethical behavior within the scope of job	5    4    3.5    3    2    1    N/A
17. Shows initiative in learning new jobs and accepting new tasks	5    4    3.5    3    2    1    N/A
18. Demonstrates professional growth and mature decision-making	5    4    3.5    3    2    1    N/A
19. Performs job tasks occasionally even if not part of job description	5    4    3.5    3    2    1    N/A
20. Understands need for adhering to set schedules and deadlines	5    4    3.5    3    2    1    N/A

Supervisor: ______________________________ Date:  ___________________
Student: ________________________________  Date:  ___________________