Exercise Science Student Practicum Evaluation Form - Central Oregon Community College

Name of student being evaluated:*

Name of Practicum Site (business): *

Name/credentials of Practicum Mentor:*

Practicum Mentor’s Position in company: *

Practicum Site Contact Info (phone):*

Practicum Site Contact Info (e-mail):*

Quarter:*

Year: (20..)*

Please rate Please rate the student (1-5) in the following areas. Your feedback is greatly appreciated.

5 = Always, 4 = Most of the time, 3 = Sometimes, 2 = Rarely, 1= Never

Student communicates effectively with the staff & the public.

5

4

3

2

1

Student acts & dresses appropriately & professionally.

5

4

3

2

1

Student is a good listener and asks good questions of the mentor.

5

4

3

2

1

Student is responsible, reliable and shows up on time.

5

4

3

2

1

Student shows enthusiasm towards the practicum.

5

4

3

2

1

Student has an adequate knowledge base for the practicum.

5

4

3

2

1

Student is respectful of the staff and the public

5

4

3

2

1

Student shows initiative and creativity.

5

4

3

2

1

Student showed significant effort to learn from you

5

4

3

2

1

Student represented COCC in a positive manner.

5

4

3

2

1

What over-all grade would you give the student for their practicum?

A.

B.

C.

D.

F.

Please list 3-5 positives/strengths of the student’s practicum performance.

Please offer at least two or more constructive suggestions to help the student in the future. For example, what knowledge &/or skills do they currently not possess that they need to gain for the future?*

Any other comments regarding student’s performance / abilities / knowledge?

Student completed:*

if you chose "other" please enter number of hours completed:

Signature of practicum mentor: by checking this box I agree that this information is accurate to the best of my knowledge.

I agree

Enter your initials to certify that you agree with the statement above.*