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Cooperative Education
Preliminary Assessment by Student

To be completed near the beginning of your Cooperative Education experience. A copy of this completed form will be sent to your faculty coordinator and employer supervisor.

STUDENT INFORMATION

Student Name
Email
Phone
Today's Date

SEMESTER AND YEAR

EMPLOYER CONTACT INFORMATION

Supervisor's Name
Company/Organization
Employer Phone Number
Employer Email Address

Assessment of Your Skills.

In order to provide a baseline profile at the completion of your work-based learning experience, we would like you to assess your competencies and performance for the following set of skills. Base your assessments on the skill levels of your coworkers at the organization.

Assessment scale: 0 to 10

0 = Lacks skill

2 = Minimal skill level

5 = Average

7 = Above average

10 = Exceptional

n/a = Not Applicable

COMMUNICATION

**COMMUNICATION**
			0	1	2	3	4	5	6	7	8	9	10	N/A
Oral (speaking and listening)
Written (clear, accurate, informative)
Client/customer oriented, friendly, polite

SELF-MANAGEMENT

**SELF-MANAGEMENT**
	0	1	2	3	4	5	6	7	8	9	10	N/A
Judgment, makes sound decisions
Detail oriented, accurate, thorough
Performs under pressure, adaptable, flexible
Resolves conflicts
Punctual, dependable, uses time efficiently
Works independently without supervision
	0	1	2	3	4	5	6	7	8	9	10	N/A

TEAMWORK

**TEAMWORK**
	0	1	2	3	4	5	6	7	8	9	10	N/A
Teamwork, rapport with coworkers, interpersonal
Organizes and plans
Respects others, accepts criticism, tactful
Appropriate leadership/follower relationship
	0	1	2	3	4	5	6	7	8	9	10	N/A

PROBLEM SOLVING/DECISION MAKING

**PROBLEM SOLVING/DECISION MAKING**
			0	1	2	3	4	5	6	7	8	9	10	N/A
Creative, offers new perspectives
Analytical ability

INITIATIVE

**INITIATIVE**
			0	1	2	3	4	5	6	7	8	9	10	N/A
Self-confident, decisive
Completes work despite obstacles, persistent
Seeks opportunities to learn, puts in extra effort

TECHNICAL/PROFESSIONAL

**TECHNICAL/PROFESSIONAL**
	0	1	2	3	4	5	6	7	8	9	10	N/A
Technical (hardware, software)
Applies organization's technology effectively
Understands and applies knowledge/theory
Professional attitude and appearance
Honest, ethical, has integrity
	0	1	2	3	4	5	6	7	8	9	10	N/A

COMMENTS

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