Name of Bonner Student
Name of Placement Agency
Name of Placement Supervisor
Ratings: 4= Exceeds Requirements
3= Meets Requirements
2= Needs Improvement
1= Does Not Meet Minimum Requirements
N/A = Cannot evaluate
* Please provide an explanation for any rating of 1, 4 or 5
Factors Considered: / Rating: / Comments:Organization and Training
The agency is organized and prepared to host me as volunteer / 1 2 3 4 N/A
Quality of training/orientation / 1 2 3 4 N/A
Expectations clearly conveyed / 1 2 3 4 N/A
Sufficient resources provided for accomplishing
tasks / 1 2 3 4 N/A
The job description was accurate or I was allowed to modify it accordingly / 1 2 3 4 N/A
Flexibility of supervisor with scheduling
conflicts / 1 2 3 4 N/A
Supervision and Guidance
Regular, clear communication with supervisor / 1 2 3 4 N/A
Supervisor was accessible, approachable —open to ideas, suggestions, concerns / 1 2 3 4 N/A
Supervisor allowed you to accept responsibility/utilize personal skills / 1 2 3 4 N/A
Quality of feedback from supervisor / 1 2 3 4 N/A
Support and Development
Overall attitude of agency toward you / 1 2 3 4 N/A
Supervisor provided a variety of challenging and productive tasks / 1 2 3 4 N/A
Supervisor/agency was willing to teach new skills or set up learning opportunities / 1 2 3 4 N/A
Overall
Overall quality of placement / 1 2 3 4 N/A
Overall relationship with supervisor / 1 2 3 4 N/A
Overall performance of supervisor / 1 2 3 4 N/A
Additional Comments: Questions to consider
Do you feel that this agency should continue to be a Bonner Program placement?
Would you work for this agency again? Why or why not?
Would you recommend this agency to an incoming Bonner? Why or why not?
Do you have any suggestions for improving the agency?
Other comments:
Student’s Signature: ______
Return to:
Name of Bonner Program
Address
City, State Zip
Fax: XXX-XXX-XXX
Email: XXX
Thank you!