Dear Faculty Member:
Please assess EOPS/CARE/MCP students taking your classes, when requested, using this form.

In order to maintain eligibility, a periodic evaluation has to be made to determine whether EOPS/CARE/MCP students are attending classes and making satisfactory progress. To initiate an accurate assessment and take appropriate action, we ask for your cooperation. Your feedback and/or suggestions are very important. If you find that the student's status is not addressed by this form, please call the EOPS Department at ext. 7207.

All required fields are listed in Red

Student Information -
* Student Name:
* Student ID Number:
(8 digits, use no dashes)
Summer    Fall    Winter    Spring
Academic Year:
*Course name & number:
Which Evaluation:
First    Second

Rate the student's performance using the codes and sub-codes (below).
Recommend as tutor
Failing performance on exams
Above Average
Attending regularly/no grade yet
Recommend tutoring
Irregular Class Attendance
Lacks preparation of assignments
Below Average
Refer to counselor
Must take prerequisite classes
Incomplete assignments
Comments or suggestions?

Faculty / Staff Information -
* Instructor Name:
* Your Department:
* Contact Phone:
* Contact eMail:

Form Validation -

Please complete this Form Validation field before submitting the form.If you can't read the sample words, use the Refresh button refresh button to get a new set of words. Or use the Audio Clue button audio button to listen to a phrase.

Close Window when finished.