Workplace Mentor Assessment Form:

Student Name:
Job Placement:
Mentor:
Date:
Part 1. Completed by the student
Please list the skills from your Learning Plan that were covered. Give a brief description of
each.

Which skills do you feel least comfortable with, or think you need more time to develop? Why?

Workplace Mentor Assessment Form:

Student Name:
Job Placement:
Mentor:
Date:
Part II. Completed by the Mentor
Please assign a numerical value 1-5 to each statement. 1 is the smallest, 5 is the biggest.
Student showed up to work on time. _____________
Student efficiently used his or her
time.

____________

Student asked questions while

learning a new skill.

_____________

On the previous page, students

accurately described each skill.

_____________

Total

_____________

Of the skills listed on the previous page, which skills do you think the student needs more time to
develop and why?

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