Gross Catholic High School
Catholic Social Justice Class
Mr. Jim Homan, teacher
734-2000

Student's Name ______________________________________________________  issue __________ 

Individual Student
Supervisor's Evaluation:
due: April 13

Dear Supervisor:

Thank you very much for allowing our Gross Catholic High School student to volunteer at your agency.  We would appreciate it very much if you could take a few moments to evaluate the above named student.

Thanks again,

Mr. Jim Homan

TO BE FILLED OUT THE LAST TIME THE STUDENT VOLUNTEERS

PLEASE PRINT AND USE INK. THIS FORM IS VOID IF ANYTHING IS CROSSED OUT OR ERASED.

Please evaluate the student using the following scale: 

5=excellent   4=good   3=average   2=fair   1=poor

A. Promptness _____ 

B. Respect for others _____ 

C. Cooperation _____ 

D. Overall positive attitude _____

PLEASE CIRCLE THE NUMBER OF TOTAL HOURS OF VOLUNTEER TIME COMPLETED BY THE STUDENT

1  2  3  4  5  6  7  8  9  10  11  12  13  14  15

Supervisor's signature _______________________________________________________

Supervisor's printed name and phone # ___________________________________________