Chabot College
SERVICE-LEARNING COMMUNITY SITE STUDENT ASSESSMENT FORM
Dear community site supervisor:
We appreciate your taking the time to complete this student assessment form. The following information will not be
used to determine student grades other than to verify that the student did complete the service experience. However,
this information is very valuable, and helps us determine ways that community agencies can be better served by
service-learning students. If you have any questions, please contact your student’s course instructor, or Chabot’s
service-learning coordinator, Clara McLean (cmclean@chabotcollege.edu).
Student Name:
Student’s Chabot College Course/Instructor:
Community Site:
Site Supervisor (Your Name):
Today’s Date:
1. Did the student complete their commitments/project for your agency, including the required 10
hours? Please mark an “X” in the appropriate box:
YES
NO
Comments:
2. If applicable, how many additional hours beyond the required 10 hours did the student
volunteer with you?
3. Please use the chart below to evaluate the student on each item, marking an “X” in the
appropriate column. If you have not had an opportunity to observe the student in this respect or if
the item is not applicable, please mark the “N/A” column.
The student:
Was reliable (followed through on
scheduled hours, was punctual, completed
tasks according to agreed schedule)
Showed sensitivity to the diversity of our
clients
Demonstrated growth in understanding the
agency’s purpose and mission
Communicated appropriately with staff
Worked cooperatively in a team
Had a positive attitude
Put forth effort to learn about the agency
and the community it serves
Had a positive impact on the agency’s
efforts to meet community needs
Strongly
Agree
Agree
Disagree
Strongly
Disagree
N/A
4. Overall, the quality of the student’s contributions was: (Please place an “X” in appropriate
box)
Excellent
Good
Fair
Poor
Comments:
5. Please provide any additional feedback here on the student’s contribution to your site or the
service-learning program:
Site Supervisor Signature:
(disregard if you are emailing the form)
Thank you very much for your feedback!
Please mail or email this form to:
Clara McLean/Susan Gill
Service-Learning Coordinators
Chabot College
Division of Language Arts
25555 Hesperian Blvd.
Hayward, CA 94545
Email: cmclean@chabotcollege.edu, or
sgill@chabotcollege.edu