1. Please evaluate the student in the following areas:

       

       

      Worksite Learning  

      Student Learning Plan and Evaluation

       
      Student_____________________________________________School _________________________________________ Supervisor___________________________________________Worksite__________________ _____________________ Worksite Phone #         Job Title_________________________________ ____________ Job Description____________________________________________________________________ __________________

      Learning Objectives: The following describe specific skills the student is to learn and/or tasks to perform as part of this workplace experience.

       

      Learning Period: From ____/____/____  To: ____/____/____   WBL Site Supervisor: _____________________

      Student Signature: ___________________________________________________________ Date: __________________

      Please evaluate the student in the following areas:

      Rating Scale : 3=Exceeds work place standards, 2=Meets workplace standards, 1=below workplace standards, NA=Not Applicable

       
       
      LEARNING TASKS/LEARNING OBJECTIVES
      		 3 2 1 NA
      1       
      2     
      3     
      4     
      5     
       
      SCANS FOUNDATION EVALUATION
      COMMENTS
      		 3 2 1NA
        BASIC SKILLS     
      1 Reading skills for job     
      2 Writing skills for job     
      3 Math skills for job     
      4 Speaking skills for job     
      5 Listening skills for job     
      6 Technology skills for job     
             		THINKING SKILLS       
      7 Follows job safety and health rules      
      8 Follows directions and ask for clarification       
      9 Shows good judgment (plans tasks)      
      10 Problem solving       
      11 Decision making       
             		PERSONAL QUALITIES      
      12 Demonstrates punctuality     
      13 Meets attendance standards     
      14 Gives timely notice of absences     
      15 Maintains appropriate personal hygiene and dress       
      16 Cooperates with co-workers     
      17 Responds appropriately to supervisors       
      18 Demonstrates appropriate work-site behavior       
      19 Reacts appropriately to constructive criticism       
      20 Completes tasks/assignments on time      
      21 Shows initiative (self starter)     
      22 Is responsible (business-like attitude)       
      Evaluations for cooperative work-based learning WSL will be conducted two times during each transcripted period. Instructional WSL will be evaluated once every 30 hours or six times per 180 hours of enrollment.

      The School District as an educational institution and as an employer does not discriminate on the basis of race, religion, ethnicity, age, disability, sex, marital or veteran status. This is a commitment made by the District in accordance with federal, state, and local laws and regulations.

       

      ____________________________________________________ ___________ ____________________________________________________ _____________

      WBL Site Supervisor Signature   Date Student Signature*         Date

       

      _____________________________________________________ ___________ *Student’s Signature denotes review of the Evaluation

      WBL Coordinator Signature   Date

       

       

      Back to top