444 W. Third St., Room 14324 Dayton, OH 45402 (937) 512-2040

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444 W. Third St., Room 14324
Dayton, OH 45402
(937) 512-2040
(937) 512-5015 (fax)
[email protected]
SERVICE LEARNING
SITE EVALUATION
HOURS LOG
Student Name
Tartan I.D. #
Phone Number
Course (example: ‘CIS’)
Course # (example: ‘278-05’)
Instructor
Agency Name
Supervisor’s Name
Agency Phone Number
Brief Description of Project
Student’s Performance Rating
Above
Average
Average
Below
Average
Unable
To Rate
Quality of service
Willingness to work
Cooperative attitude
Works well with others
Acceptance of supervision
Takes Initiative
Courtesy
Dependability
Personal Grooming
Punctuality and attendance (Did student call if late or absent?)
TO BE SIGNED AND COMPLETED BY SUPERVISOR(S) ONLY
Date of Service
TOTAL HOURS SERVED
Hours Spent on Site/Project
______________
Supervisor’s Signature
Comments
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