Cispus Counselor Feedback Form
Counselor First Name *
Your answer
Counselor Last Name *
Your answer
Staff Name
Place your name here, if you are a staff member who observed the counselor at camp.
Your answer
Counselor Gender *
Counselor Grade
Scores
4 = Exceptional 3 = Good 2 = Fair 1 = Did not meet expectations
INTRODUCTION, RAPPORT WITH STUDENTS
Rapport was built because:
I planned introduction activities to build relationships among, and with, students in my cabin.
I developed healthy, kind relationships with all students in my cabin.
I was patient and did not over react.
I was fair and honest, handling student interactions and interventions with respect and dignity.
I was supportive and understanding with students and adults.
I focused energy on INCLUDING ALL students in activities and relationships. I made sure all the students in my cabin were included. My conduct promoted inclusion among students and discouraged exclusive behavior.
I was a positive role model.
I effectively balanced having fun, with when to draw the line.
Our skits, songs, activities and games included everyone and were not humiliating or hurtful to anyone, honoring race, gender, and person. There was no inappropriate language or actions.
INTRODUCTION, RAPPORT WITH STUDENTS - COMMENTS
Your answer
SAFETY
Safety was attended to because:
I was alert to safety and medical issues with students.
I knew when to stop "horsing" around.
I followed rules and directions.
I did not bring illegal substances.
No sharp objects or matches were used except when directed. I was a good role model for safety.
No one was lost and no one hurt anyone.
SAFETY - COMMENTS
Your answer
ENVIRONMENTAL VISION FOCUS
I set a good example of environmental awareness with peers and students (i.e. stayed on trails for hikes and adventures, didn't litter, etc.)
I tried hard to emphasize learning about the environment.
Some of our songs, skits and activities had an environmental connection.
ENVIRONMENTAL VISION FOCUS - COMMENTS
Your answer
PARTICPATION / CONTRIBUTION
I learned and taught.
I portrayed a positive attitude to students.
I made sure that all students had an invitation to participate.
I had fun. I was energetic and happy.
I was active, responsive, and involved in all camp activities and was willing to help wherever and whenever needed (with a positive attitude).
I was on time.
PARTICPATION / CONTRIBUTION - COMMENTS
Your answer
CLOSURE
I planned a meaningful closure (good-bye) event with the students in my cabin.
I planned closure, giving them a sense of what was accomplished, enjoyed, and important.
I provided students an opportunity to talk about their experiences (good / bad) and helped them with their feelings about Outdoor School ending.
I stayed enthusiastic until the very end.
CLOSURE - COMMENTS
Your answer
FINAL COMMENTS
What were your biggest concerns about camp?
Your answer
What were the best things about camp?
Your answer
Thank you for the feed back! It will help make the Outdoor School experience even better next year!
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