"Service-Learning Project Student Evaluation Form - Eastern Virginia Medical School"

Service Learning Project Site

Student’s Name

EASTERN VIRGINIA MEDICAL SCHOOL

Service-Learning Project Student Evaluation Form

Thank you for allowing EVMS and our students to partner with you to conduct a Service Learning project. Your feedback is very important to us. Thank you for

taking the time to fill out this evaluation form for each student. Please note that your evaluation of the student will not be the sole factor in determining the

student’s pass or fail rating for this course.

Evaluators Name: _____________________________________________________________

Evaluators Title: ______________________________________________________________

Date of Student Participation (mm/dd/yy): ____________________ Time Start:_____ Time End_____

Evaluator’s Email Address: _______________________________

EVALUATION OF STUDENT PERFORMANCE

Please rate the students’ performance in the following areas:

1. Did the student arrive on time?

Yes

2. Did the student actively participate in the task assigned?

Yes

3. Did the student appropriately interact with staff?

Yes

4. Did the student appropriately interact with patients/clients?

Yes

5. Would you like to speak with EVMS faculty or staff about the student?

Yes

Student Strengths

Student Weakness

Please write any additional comments you would like to express about the student participant in the box below:

Evaluator’s Signature________________________________________ Date _______________________