This form is intended to be used by the students as a tool for self-evaluation and by the center administration as an evaluative tool. One copy will be completed by the student, another by the head and assistant teachers of the classroom(s) in which the student worked. After completing the form a conference between the student and the teacher from the classroom in which the majority of the time was spent should be scheduled in order to discuss the evaluation.

Use the following scale to complete the form:
3 : This statement is true almost all of the time
2 : This statement is true more often than not
1 : This statement is seldom true
0 : This statement is never true

_____ l. Is friendly, with an ability to relate positively to people.
_____ 2. Dresses comfortably and neatly.
_____ 3. Is punctual.
_____ 4. Is dependable.
_____ 5. Works efficiently and is energetic.
_____ 6. Shows an ability to accept and use constructive suggestions.
_____ 7. Asks for guidance/clarification regarding policies and procedures.
_____ 8. Models appropriate behavior for the children.
_____ 9. Demonstrates patience and empathy.
_____10. Smiles and shows enjoyment often.
_____11. Maintains supervision of group even when dealing with an individual child.
_____12. Shows initiative.
_____13. Demonstrates respect for children in language used and behavior.
_____14. Interacts with all the children, showing no favoritism.
_____15. Encourages independence in the children.
_____16. Speaks in a clear, calm and quiet voice.
_____17. Refrains from calling across the room or playground to a child.
_____18. Gives children unambiguous messages.
_____19. Has reasonable expectations for children.
_____20. Gives guidance in positive ways.
_____21. Is able to be firm yet kind when children's behavior becomes difficult.
_____22. Stoops, kneels or sits to speak with children at their eye level.
_____23. Promotes problem solving, including social problem solving.
_____24. Shows patience and empathy.
_____25. Facilitates interactions between children; avoids becoming a "playmate"
_____26. Sits and converses with children during snacks and meals.
_____27. Washes hands before serving food and after changing diapers.
_____28. Follows center policies.

COMMENTS:

Signed:

Student assistant_______________________________ Date: ________________

Head teacher ___________________________________ Date: ________________

Director or Assistant Director ______________________ Date: ________________