Download a Word Document file of this worksheet here.
COOPERATIVE EDUCATION
GRADE REPORT WORKSHEET
Date of Grade Report:___________________________________________________________
Student Name:__________________________________________________________________
Last First MI.
Curriculum Program:____________________________________________________________
Course number ______________ Section ______ Semester:_____________
Employer_____________________________________________________________________
Supervisor ____________________________________________________________________
Employer Address ______________________________________________________________
Faculty Coordinator _____________________________________________________________
- Attendance (Total Hours Worked) Assessment: ________________
- On-Site Evaluation Assessment (if conducted) ________________
- Mid-term Evaluation Assessment: (if conducted) ________________
- MLO 1 Assessment: ________________
- MLO 2 Assessment (if applicable): ________________
- MLO 3 Assessment (if applicable): ________________
- Employer Evaluation: ________________
- Student Self-evaluation Assessment: ________________
- Faculty Coordinator Assessment: ________________
FINAL COURSE GRADE ________________
Comments:
___________________________________________________ _________________
Faculty Coordinator Signature Date
Civil Rights and Non Discrimination Statement
It is the policy of the Virginia Community College System and Mountain Empire Community College to provide equal employment and educational opportunities for all persons without regard to race, color, religion, national origin, political affiliation, veteran status, gender, age, or sexual orientation and for all otherwise qualified persons with disabilities. This policy permits appropriate employment preference for veterans. This institution promotes and maintains educational opportunities without regard to race, color, sex, ethnicity, religion, gender, age (except when age is a bona fide occupational qualification), disability, national origin, or other non-merit factors. This institution prohibits sexual harassment including sexual violence.
The following person has been designated to handle inquiries regarding non-discrimination policies: Ron Vicars, Vice President of Financial and Administrative Services. The following person has been designated to handle inquiries regarding student misconduct or equity issues based on gender: Lelia Bradshaw, Dean of Student Services. The following person has been designated to handle inquiries regarding employee misconduct or equity issues: Pam Giles, Human Resource Manager. For more information, contact 276.523.2400, 3441 Mountain Empire Rd., Big Stone Gap, VA, 24219. Virginia relay users dial 711.
