Cispus Counselor Feedback Form

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Counselor First Name *

Counselor Last Name *

Staff Name

Place your name here, if you are a staff member who observed the counselor at camp.

Counselor Gender *

Male

Female

Counselor Grade

Senior

Junior

Sophomore

Other:

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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.

Clear selection

I developed healthy, kind relationships with all students in my cabin.

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I was patient and did not over react.

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I was fair and honest, handling student interactions and interventions with respect and dignity.

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I was supportive and understanding with students and adults.

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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.

Clear selection

I was a positive role model.

Clear selection

I effectively balanced having fun, with when to draw the line.

Clear selection

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.

Clear selection

INTRODUCTION, RAPPORT WITH STUDENTS - COMMENTS

SAFETY

Safety was attended to because:

I was alert to safety and medical issues with students.

Clear selection

I knew when to stop "horsing" around.

Clear selection

I followed rules and directions.

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I did not bring illegal substances.

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No sharp objects or matches were used except when directed. I was a good role model for safety.

Clear selection

No one was lost and no one hurt anyone.

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SAFETY - COMMENTS

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.)

Clear selection

I tried hard to emphasize learning about the environment.

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Some of our songs, skits and activities had an environmental connection.

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ENVIRONMENTAL VISION FOCUS - COMMENTS

PARTICPATION / CONTRIBUTION

I learned and taught.

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I portrayed a positive attitude to students.

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I made sure that all students had an invitation to participate.

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I had fun. I was energetic and happy.

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I was active, responsive, and involved in all camp activities and was willing to help wherever and whenever needed (with a positive attitude).

Clear selection

I was on time.

Clear selection

PARTICPATION / CONTRIBUTION - COMMENTS

CLOSURE

I planned a meaningful closure (good-bye) event with the students in my cabin.

Clear selection

I planned closure, giving them a sense of what was accomplished, enjoyed, and important.

Clear selection

I provided students an opportunity to talk about their experiences (good / bad) and helped them with their feelings about Outdoor School ending.

Clear selection

I stayed enthusiastic until the very end.

Clear selection

CLOSURE - COMMENTS

FINAL COMMENTS

What were your biggest concerns about camp?

What were the best things about camp?

Thank you for the feed back! It will help make the Outdoor School experience even better next year!

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