student name________________

class________________________
 

student's participation:
_____ excellent

_____ good

_____ satisfactory

_____ needs to show more of an effort
 

instructor's comments:
 
 
 
 
 

out-of-class activities (extra-curricular, family activities, etc.):
 
 
 
 
 
 
 

parent/guardian signature:

________________________

student signature:

________________________

date:

______________