HOST TEACHER/STUDENT OBSERVER
EVALUATION

Kindly take a few moments to complete the checklist below. Any comments you care to share with the instructor, coordinator and student would be welcome. Thank you again for your commitment to quality education!

Student Observer Name ___________________________________________

Semester ____________ Host Site ___________________________________

Yes	No	See Comment

____	____	____		Was the student observer punctual?

____	____	____		Did the student complete observation hours?

____	____	____		Did the student notify you of schedule changes?

____	____	____		Was student observer professional in appearance?

____	____	____		Did the student conduct self in professional manner?


Comments:





Host Teacher Signature ____________________________________________


Please return in student folder, or for reasons of privacy, fax to 845-344-6230 
or mail to:

Katherine Sinsabaugh, Field Placement Coordinator
Education Department
SUNY Orange
115 South Street
Middletown, New York 10940




Revised 08/03/10