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CALAYAN EDUCATIONAL FOUNDATION, INC.

COLLEGE OF ARTS AND SCIENCES


BS PSYCHOLOGY PROGRAM

Name of student: ______________________________________________________

Practicum Facility/Institution: _____________________________________________

Name of Immediate Supervisor: __________________________________________

Practicum Period Covered: ______________________________________________

Number of Hours Rendered: _________

FOR THE SUPERVISOR: Based on the maximum score per item, kindly indicate your
ratings
for each of the items below
Maximum Rating
Score
I. TASK PERFORMANCE (45%)

A. JOB KNOWLEGDE _______


More than Average 15
Average 10
Very Basic 5

B. QUALITY OF WORK _______


Excellent 15
Average 12
Fair 8
Poor 3

C. QUANTITY OF WORK _______


Exceeds expectations 15
Meet expectations 10
Does not meet expectations 7

D. OBSERVED WORK RELATED ATTITUDES (30%) _______

Industry 3
Dependability 3
Integrity/Honesty 3
Cooperativeness 3
Courteousness and Politeness 3
Willingness to Learn 3
Work Attitude 3
Sense of Urgency 3
Personality 3
Responsibility 3

II. ATTENDANCE AND PUNCTUALITY (25%)

A. Attendance _______
Always Present 13
Seldom Absent 10
Always Absent 5

B. Punctuality _______
Always Present 12
Seldom Absent 9
Always Absent 6

Grand Total _______

NAME AND SIGNATURE OF


IMMEDIATE SUPERVISOR

Head of Department Office