"Service-Learning Project Student Evaluation Form - Eastern Virginia Medical School"
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1Service 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
No
N
2. Did the student actively participate in the task assigned?
Yes
No
3. Did the student appropriately interact with staff?
Yes
No
4. Did the student appropriately interact with patients/clients?
Yes
No
5. Would you like to speak with EVMS faculty or staff about the student?
Yes
No
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 _______________________
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
No
N
2. Did the student actively participate in the task assigned?
Yes
No
3. Did the student appropriately interact with staff?
Yes
No
4. Did the student appropriately interact with patients/clients?
Yes
No
5. Would you like to speak with EVMS faculty or staff about the student?
Yes
No
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 _______________________
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DD Form 2813
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DA Form 2062 "Hand Receipt/Annex Number"
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DD Form 2977 "Deliberate Risk Assessment Worksheet"
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DD Form 1750 "Packing List"
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