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