A.1.Level II Weekly Review

Level II Fieldwork review of student performance submitted weekly except mid-term (week 6) and final (week 12)

Facility Name *
Week # *
Student Name * First Last
Student Email *
Strengths *
Areas/Opportunities for Improvement *
Goals Met/Goals Due Next Week *
Comments/Other Information
# Days Absent this Week * 0 1 -2 3 or More
# Days Tardy this Week * 0 1 - 2 3 or More
Level of Supervision Needed (Educator Response) * More Less Just Right
Level Of Supervision Needed (Student Response) * More Less Just Right
Behaviors indicate interest in learning * Agree Disagree See comments
Positive professional behavior (i.e. respect for time, dress, accepting feedback, interactions, comments, etc.) * Agree Disagree See comments
Self-directed learning/initiative * Agree Disagree See comments
Asks for needs/feedback * Agree Disagree See comments
Carryover, adjusts performance based on feedback * Agree Disagree See comments
Demonstrates safety, HIPAA * Agree Disagree See comments
Fieldwork Educator Signature
Typing your name below attests that you have collaborated with and/or reviewed this form with the student.
Fieldwork Educator Name * First Last
Fieldwork Educator Credentials *
Fieldwork Educator Email Address *
Student Agreement
Typing your name below attests that you have collaborated with and/or reviewed the form with your Fieldwork Educator.
Student Name * First Last
Date * / MM / DD YYYY
Almost Done!
Once you hit "Continue" below, you'll be taken to a preview page where you can review your responses.

PLEASE NOTE: We will not receive this evaluation until you hit "Submit" on the next page.
Once you hit submit, you will receive an email receipt of the evaluation.
Thank you for taking the time to submit this weekly review.

A.1.Level II Weekly Review

A.1.Level II Weekly Review

Fieldwork Educator Signature Typing your name below attests that you have collaborated with and/or reviewed this form with the student.

Student Agreement Typing your name below attests that you have collaborated with and/or reviewed the form with your Fieldwork Educator.

Fieldwork Educator Signature
Typing your name below attests that you have collaborated with and/or reviewed this form with the student.

Student Agreement
Typing your name below attests that you have collaborated with and/or reviewed the form with your Fieldwork Educator.