Supervisor Evaluation

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Student Name *
Dates worked *
Agency Name *
Agency Address
Supervisor Name *
Supervisor Phone Number
Supervisor Email
Total Number of Hours Student Worked *
What were the student *
Was the student punctual? *
No, not at all
Occasionally late
Yes, Always on Time
Did the student go beyond the minimal requirements? *
No
Yes
Not Applicable/ Opportunity not available
If so, how?
Did he student follow instructions well? *
No
Required some follow-up
Yes
Did the student work well with employees? *
No
Yes
Not Applicable
Did the student demonstrate a positive attitude? *
No
Occasionally
Yes
Did the student encounter any unusual difficulties? *
No
Yes
If so, please explain.
Overall, was your experience with this student a positive one? *
Yes
Neutral
No
Overall, do you feel this student was able to contribute positively to her/his community? *
No
Somewhat/Neutral
Yes
Has your agency hosted NCSSM students completing their Summer Service requirement before? *
No
Yes
Would your agency like to host another NCSSM student for their Summer Service requirement? *
No
Maybe
Yes
If your organization is near Durham, are there volunteer opportunities during the school year that students at NCSSM might be able to participate in?
No
Yes
If yes, please describe:

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