This evaluation form assesses a student's skills and performance in an educational program at Mid-State Technical College. The student attended from January 2002 to November 2004 and received satisfactory ratings in areas like work habits, communication, cooperation, responsibility, and cultural awareness. Instructors commented that the student was productive and stayed on task. The form provides the student's name, ID number, courses, and instructor's signature for documentation purposes.

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L.at.ins For Lif. Form
Student's Name:
Program: Cl9 -
This Evaluation is
Student lD No:
Mo./Yr. of Graduation:
Based on Course(s):
Student
Reference
Dales Attended i.4STC: Fro/n Imonth &.yeaf):. T5.IUA.i 2OuZ to (month & year): N 2-Ot,<
rnstructor's sisn^tur"
)//^),- u/;'-/..l'- oate {r/zo,/O? "
working Producti Assurinq Quality
An individual possesses and applies elfeclive work habiis and altiludes wilhin an
organ,zal.onal lclassroom, lab. or shop) senrng.
Rating
2 1 N
1. Manages time and wcrk lcaC (assign$enls, prcjects) V/
2. Follows salety procedures / rules l-,'
3. Handles responsibillty in a dependable manner l-/
4- Carries out instruclions
Learnin Efrectively
An individual possesses necessary basic skills ln reading, writing. and compuling;
applies skills in acquiring iniormation; and uses learning tools and siIategies.
2- Uses learning resources
3. Organizes iniomation
Communicating
RalingAn individual is able to aPPIY
precisely convey inlormalion,
appropriate writing, speaking,
ideas, and opinions.
and lislening skills in order lo
1 Apples lhe Engllsh language correcly (sPelling, gammar, slruclure)
2 Speaks underslandably
3. Wriles undersiandably
4 Demonslrales abilty to ljslen ellecljvely
5 Uses anguaqe aPp,oPaare Io siluatron

2. Working Cooperatively
ian rrcrv,cual is capablo ol working wrll cthels lo compl€ts lasks'
.. re . ! e'!::. '"s.1"€ ..n!l:.::. iI..":e :.1.=?!!^"nc ^fiE' SUFPO'I
1.
'
ro"s coop€'"trvsly wilh oth€rc (classroom, shop, P6cticing)
IIEfi on"lrates ,."p.a lor others through word and aclion
3. Provid€s and eccepts loedbacl(
An individual rscognEes an obligation to sell and others lor his or h6r decisions and actions'
1. At!6nds class regularly and punctually
I-7IL:mes resPonsioitity ror compleling assignments
3. Psdorms assigned tasks
ifT-*s procuctivety and stays on task
Comment3:
Comments:
An individuat uses lhe Principles ol science and recognizes the impacl o' iechnology'
[monstratestechnologicalliteracy
Comments:
Demonstrating A-'riareness
ffirgroup behaviors in cross- cuttulal
i"i"i""i,"""
""a "tet*
social intelaclion in a lartetv ol snualions
1. Fespecls cullural dilJerences
ft6iliiii"at"" in , cullurallv sensilive manner
(print nahe ol
classroom and/or
Studeni's Signatu
Please return comPleled form lo:
' '-
tl,o-State lecnnlcal College Career Servrces Olfce'
Phcne NLrmber: (715't 422-5445 ot O15') 422'5362
E.Marl: careerservices@midstate tec'wi us'
5oo 32nd Street North, Wisconsin Rapids. Wl 54494
FAX Number: c/15) 422-5440
Web Page Address: www.midstate'tec'wl us
Mid-State Technicat Coltege is An Equat opportu;ity/Affirmative Action Educator and EmployeL