
COMMUNITY HEALTH EDUCATION STUDENTS
HUNTER COLLEGE SCHOOL OF HEALTH SCIENCES

STUDENT: ________________________ SITE SUPERVISOR: _________________________

NAME OF AGENCY: ___________________________________________________________

DATES OF PLACEMENT: ___________________

Please write letter grade in each appropriate box	NO OPPORTUNITY TO OBSERVE	EXCEPTIONAL (A+, A, A-)	ABOVE AVERAGE (B+,B,B-)	NEEDS IMPROVEMENT (AVERAGE)(C+,C,C-)	WORKING TO IMPROVE (BELOW AVERAGE)
A. PROFESSIONAL QUALITIES 1. Appreciation and knowledge of: technical and political climate within which agency works.
Health education principles and concepts
2. Skills In: Planning
Implementation
Organizing
Program analysis and evaluation
Consultation
Writing
Verbal communication
Teaching
Health Counseling

Please write letter grade in each appropriate box	NO OPPORTUNITY TO OBSERVE	EXCEPTIONAL (A+, A, A-)	ABOVE AVERAGE (B+,B,B-)	NEEDS IMPROVEMENT (AVERAGE)(C+,C,C-)	WORKING TO IMPROVE (BELOW AVERAGE)
B. OVERALL PERFORMANCE 1. Establishes friendly relationship with coworkers.
2. Considers and incorporates the ideas of others.
3. Organizes and uses time effectively.
4. Is able to facilitate work of committees and other groups.
5. Submits accurate, well documented work and reports.
6. Accepts responsibility and completes work assignments.
7. Raises innovative ideas and brings out creative and innovative ideas in others.

C. COMMENTS: (Please comment briefly)

1. Special strengths:

2. Skills and knowledge needing further improvement:

3. Other comments:

Site Supervisor's Signature__________________________________ Date: _____________

Please return to: Dr. Barbara Berney, UPH, Coordinator of Fieldwork, Hunter College School of Health Sciences,
425 East 25th Street, NYC, NY 10011. THANK YOU!!