Evaluation Form

Evaluation Form

Evaluate yourself in these areas. Others may rate you also.
Rate yourself using the following scale.
Number of incident reports ___________
1 – Unacceptable
2 – Below average
3 – Average
4 – Above average
5 – Excellent

Moral character:

Being Nice, Honest, Trust-worthy, Self, Control, Motivation, Sexual Safety, Apologies ,How did you get along with your peers and adults
SELF

Communication skills, respectful eye contact, Impulse control, Respectful to others, Attitude, Admits mistakes, Not bickering, Obey rules,
SELF

Recognizing limitations and adapting, Positive self talk, On track to advance level, Appropriate dress, Leader-ship, Interaction with Holly Interaction with Hanna,
SELF

Comments:

Job:

Attitude, On time, Appropriate dress, Staying on task, Work done in a timely fashion, Prepared for work, Do extra
work, On track to go up a level, Nice to be around,
SELF

Did you get along with your peers, Not bickering, Accept constructive feedback, Appropriate decisions, Strive for continuous improvement,
SELF

Comments:

Education:

Attitude, Staying on task, Work Done in,
A timely fashion, Motivation ,Doing extra
work, Prepared for class, Nice to be around, Strive for continuous improvement,
SELF

Comments:

Life skills:

Cooking, Cleanup, Money
Management, PE, Job, On track to
go up a level, Nice to be around, Keeping room Cleaned, Lights off at appropriate time,
SELF

Comments:
What skills have you improved on?
______________________________________________________ ______________________________________________________ ______________________________________________________ _____________________

List Other Skills You Are Working On?
______________________________________________________ ______________________________________________________ ______________________________________________________ _____________________

Goals?
______________________________________________________ ______________________________________________________ ______________________________________________________ _____________________

How have you done this week?

What are you feeling (thinking journal)? (Great, discouraged, not sure etc.) ______________________________________________________ _______
______________________________________________________ ______________________________________________________ ______________

Do you want to move up a level – Yes or No? What would be the advantage? ______________________________________________________ _______
______________________________________________________ ______________________________________________________ ______________

Do you feel you should move up a level? ____________________________
______________________________________________________ ______________________________________________________ ______________

Do you feel that you should move up a level? Why or Why not?
______________________________________________________ ______________________________________________________ ______________________________________________________ _____________________

Have you asked the team members what they think you need to do to move up? ______________________________________________________ ___
______________________________________________________ ______________________________________________________ ______________

What do you need to do to move up? _______________________________
______________________________________________________ ______________________________________________________ ______________

What areas did they say you needed to work on? _____________________
______________________________________________________ ______________________________________________________ ______________________________________________________ _____________________

Other comments: ______________________________________________
______________________________________________________ ______________________________________________________ ______________________________________________________ _____________________