EVALUATION REPORT & COUNSELING RECORD
1. Name (Last, First MI suffix)
2. Class Year
4. Period of Report
Fall
Winter
Year
5. Type of Report
Regular
Special
6. PFA/PFT
Date
3. Company-PLT-SQD
7. Ht/Wt
WS
NS
8. Swim Qualification
None
1st
2nd
9. Billet Assigned:
3rd
10. Major:
11. Awards / NROTC Extracurricular Activities:
12. Community Service Activities:
13. Date Midterm Counseling Completed
14. Name of Midterm Counselor
15. Signature of Individual Counseled
PERFORMANCE TRAITS: 1.0 – Below standards/not progressing or UNSAT in any one standard; 2.0 – Does not meet all 3.0
standards; 3.0 – Meets all 3.0 standards; 4.0 – Exceeds most 3.0 standards; 5.0 – Meets overall criteria and most of the specific standards
for 5.0. Standards are not all inclusive. (* Must be specifically justified)
PERFORMANCE
1.0*
2.0
3.0
4.0
5.0
TRAITS
Below Standards
Progressing
Meets Standards
Above
Greatly Exceeds Standards
16. Equal
- Displays personal bias
- Always treats others
- Admired for fairness and
Opportunity:
or engages in harassment
with fairness and respect.
human respect.
Fairness, respect
- Lacks respect for EO
- Does not condone bias
- Ensures a climate of fairness
for Human Worth. objectives.
or harassment in or
and respect for human worth.
- Interferes with order
outside the battalion.
- Leader and model
and discipline by
- Positively contributes
contributor to unit
disregarding rights of
to unit morale and
cohesiveness and morale.
others.
cohesiveness.
17. Organizational
Support:
Contributions
towards team
building and team
results.
Communication
skills.
- Creates conflict,
unwilling to work with
others, puts self above
team.
- Fails to understand
team goals or teamwork
techniques.
- Does not take direction
well.
- Finds excuses to get
out of battalion
activities.
- Reinforces others’
efforts, meets personal
commitments to team.
- Understands team
goals, employs good
teamwork techniques.
- Accepts and offers
team direction.
- Will volunteer if asked
to.
- Team builder, inspires
cooperation and progress.
- Talented mentor, focuses
goals and techniques for team.
- The best at accepting and
offering team direction.
- Volunteers for almost
everything.
18. Military
Bearing/
Appearance,
Physical fitness
- Unsatisfactory
demeanor or conduct.
- Consistently
unsatisfactory
appearance.
- Unable to meet one or
more physical readiness
standards.
- Excellent personal
appearance.
- Excellent demeanor or
conduct.
- Complies with physical
readiness program,
within all standards.
- Exemplary personal
appearance.
- Exemplary personal
demeanor or conduct.
- Excellent or outstanding
PRT. A leader in physical
readiness.
19. Character,
Conduct:
Adherence to
Navy Core
Values: Honor,
Courage,
Commitment,.
- Fails to live up to Navy
Core Values: Honor,
Courage, and.
Commitment.
- Frequently corrected
due to inappropriate
behavior.
- Always lives up to
Navy Core Values:
Honor, Commitment,
and Courage.
- Always behaves
correctly.
- Exemplifies Navy Core
Values: Honor, Commitment,
and Courage.
- Personal behavior clearly
marks midshipman as
superior.
EVALUATION REPORT & COUNSELING RECORD (cont’d)
PERFORMANCE
TRAITS
20. Mission
Accomplishment,
Academic effort,
Initiative: Taking
initiative,
planning,
prioritizing, and
achieving goals.
21. Leadership/
Followership,
Management:
Organizing,
Motivating, and
Developing others
to accomplish
goals
1.0*
Below Standards
- Lacks initiative
- Unable to plan or
prioritize.
- Fails to get the job
done.
- Sets unrealistic or
unchallenging goals.
- Academic achievement
has caused midshipman
to receive a PRB (second
consecutive offense).
2.0
Progressing
- Fails to motivate, train,
or develop subordinates.
- Fails to organize,
creates problems for
subordinates.
- Lacks the ability to
cope with or tolerate
stress.
3.0
Meets Standards
- Takes initiative to
meet goals.
- Plans/prioritizes
effectively.
- Always gets the job
done.
- Academic
achievement clearly
demonstrates effort.
4.0
Above
- Effectively motivates,
trains and develops
subordinates.
- Organizes
successfully, solves
problems as they occur.
- Performs well in
stressful situations.
5.0
Greatly Exceeds Standards
- Develops innovative ways to
accomplish goals.
- Plans/prioritizes with
exceptional skill and foresight.
- Gets job done earlier and
better than expected.
- Sustained superior effort.
- Significant upward trend
over previous semester.
- Inspiring motivator and
trainer.
- Superb organizer, great
foresight, gets ahead of
problems.
- Perseveres through the
toughest challenges.
22. Comments on Performance (Rater) :
Name of Rater:
23. Comments on Performance (Senior Rater) :
Name of Senior Rater:
24. Comments on Performance (Class Advisor) :
Promotion Recommendation
Significant
Problems
Progressing
Promotable
Must
Promote
Early
Promote
Individual
Summary
Peer Score
Aptitude Grade
25. Signature of Commanding Officer
Academic Term GPA
Cum. GPA
Signature of Class Advisor
26. Signature of Midshipman Evaluated
Statement provided
Revised 12/2004