Student Experience Evaluation

STUDENT EXPERIENCE EVALUATION

Institution/Program Name:

Student Information

Date of Birth:    Student ID:

Phone:    Email:

Is the student under 18 years of age? Yes

Parent / Guardian (if applicable)

Relationship:    Phone:

Program / Placement Details

Supervisor Name:    Title:

Evaluation Period: From to    Total Hours Completed:

Participation & Activities

Client interaction / service delivery   Administrative tasks   Research / analysis   Technical / lab work   Other

Learning Outcomes & Performance

Performance Ratings (1 = Poor; 5 = Excellent)

Communication: 1 2 3 4 5

Teamwork & Collaboration: 1 2 3 4 5

Problem Solving & Initiative: 1 2 3 4 5

Technical / Job-Specific Skills: 1 2 3 4 5

Professionalism & Dependability: 1 2 3 4 5

Safety, Conduct & Accommodations

Were there any incidents, safety concerns, or conduct issues during the placement? Yes No

Consent to share this evaluation with prospective employers or educational programs: Yes No

Evaluator Comments

Recommendation regarding completion/status: Satisfactory / Complete Needs further development Other

Administrative Certifications and Privacy

Certification: By signing below, the parties certify that the information in this evaluation is true and accurate to the best of their knowledge. The evaluator attests that the evaluation reflects observed performance and documented evidence. This evaluation will be retained in the student's educational record and may be used for academic credit determination, program improvement, and placement verification in accordance with applicable records retention and privacy policies.

Confidentiality: Evaluators and program staff must maintain confidentiality of student records. Information in this evaluation will not be disclosed outside the institution except as authorized by the student or guardian, required by law, or necessary for legitimate educational or placement purposes.

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