LEARNER FEEDBACK FORM Give your sincere feedback on each statement.
Name (Optional): _____________________________________________________________________________
Give your sincere feedback about _________________________________ as a teacher/adviser on each statement.
(Teacher's Name)
Strongly Strongly
The teacher/adviser... Agree Disagree
Agree Disagree
Give clear instructions ☐ ☐ ☐ ☐
Use simple example that I understand ☐ ☐ ☐ ☐
Administers discipline appropriately and consistently. ☐ ☐ ☐ ☐
Provides homework/practice that supports classroom
☐ ☐ ☐ ☐
learning.
Opens and approachable to learner's queries ☐ ☐ ☐ ☐
Treats her class with respect and care ☐ ☐ ☐ ☐
Acknowledges individual needs and provides
appropriate individual assistance to engage her class ☐ ☐ ☐ ☐
in learning
YES NO
Do you attend classes regularly? ☐ ☐
Do you submit your activities/performance tasks on time? ☐ ☐
Do you ask question if there is a need to clarify on the lesson? ☐ ☐
Any comments/suggestions for further improvement?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________
Name of the Student
Signature over Printed Name