Southeastern New England Region

 USPC

 

WORK STUDY PROGRAM

 

 

DC Evaluation Form

 

Please return this form within 1 or 2 weeks following your activity to:

Debbie Stewart

60 Warren St.

Plainville, MA 02762

 

Phone & Fax: (508) 695-3904     E-Mail:  dstewart@jpstewart.com

 

 

 

Candidate Name:                                                                                                                                  

 

Activity:                                                                                                                                               

 

Date:                                                                                                                                                     

 

Number of Hours Worked:                                                                                                                   

 

 

 

I found this candidate to be:

 

Great

Good

Needs Work

Informed

 

 

 

Knowledgeable

 

 

 

Responsible

 

 

 

Works Well with Adults

 

 

 

Works Well with Children

 

 

 

 

I would / would not recommend this candidate again.

          (Circle one)

 

Please put any additional comments on the back of this form.

 

DC:                                                         Pony Club: