Member Performance Self-Evaluation

A Michigan’s AmeriCorps Program

Celebrating 10 Years of Service 2004—2013

Member Performance Self-Evaluation

Each AmeriCorps member is to provide a self-evaluation at the midpoint and the end of the service term using the following Self-Evaluation form. In addition, Supervisor Evaluations are to be completed by the Site Supervisor. Both should be reviewed in a meeting with the Site Supervisor in order to provide useful feedback to the AmeriCorps member, as well as assist them in their future goal planning. Completed evaluations should be returned to program staff within 15 days of the required completion date.
(Revised 2014)
MEMBER NAME / Click here to enter text.
SITE SUPERVISOR / Click here to enter text.
PERFORMANCE CHECKLIST
Please check the appropriate response for each area as it relates to your AmeriCorps service:
1: I Do Not Meet Expectations 2: I Meet Expectations 3: I Exceed Expectations
PERFORMANCE CATEGORIES / 1 / 2 / 3
Appearance and Behavior / I dress, behave and speak in a professional manner / ☐ / ☐ / ☐
Punctuality and Time / I am on time and providing the required full-time service (35-40 hours) / ☐ / ☐ / ☐
Responsibility / I complete my tasks and projects as required, with attention to detail / ☐ / ☐ / ☐
Respectfulness / I demonstrate respect in all my interactions with others / ☐ / ☐ / ☐
Project Development / I am able to develop and implement ideas and projects / ☐ / ☐ / ☐
Professional Development / I take advantage of opportunities offered for learning and development / ☐ / ☐ / ☐
Goal Development / I demonstrate an ability to set and achieve my professional goals / ☐ / ☐ / ☐
Communication / I communicate regularly with others and ask questions when needed / ☐ / ☐ / ☐
Collaboration / I demonstrate an ability to collaborate effectively / ☐ / ☐ / ☐
Commitment / I display a consistent commitment in all my service activities / ☐ / ☐ / ☐
Leadership in Service / I model accountability, inspire others and practice self-discipline / ☐ / ☐ / ☐
PERFORMANCE CHECKLIST EXPLANATION
Please provide explanations for any performance categories that do not meet expectations. Explain why expectations weren’t met, and explain the steps you are taking to correct this.
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PERFORMANCE FEEDBACK
Areas of Accomplishment / Indicate, in detail, areas in which you have performed especially well
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Areas of Improvement / Indicate, in detail, areas in which you should focus future improvement efforts
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Member Impact / Indicate, in detail, areas in which your service has positively impacted others
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Site/Program Improvement / Indicate, in detail, areas in which you would like to see site or program improvement.
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AMERICORPS REQUIREMENT CHECKLIST
Please check the appropriate response for each area as it relates to your AmeriCorps service:
1: Yes (Y) 2: No (N)
COMPLIANCE CATEGORIES / Y / N
Prohibited Activities / Have you engaged in any prohibited activities as an AmeriCorps member? / ☐ / ☐
Employee Displacement / Have you served in any capacity that would displace an employee? / ☐ / ☐
Timesheets / Are your timesheets current in OnCorps Reports? / ☐ / ☐
Hourly Compliance / Are you in compliance with the hourly program requirements? / ☐ / ☐
Great Stories / Are you reporting one Great Story a month as required? / ☐ / ☐
Member Reflection / Are you completing one Member Reflection a month as required? / ☐ / ☐
Direct Service Activities / Are you reporting your Direct Service Activities as required in OnCorps? / ☐ / ☐
Service Projects / Are you planning or have you participated in any service projects? / ☐ / ☐
Learning Objectives / Have you completed Member Learning Objectives as required? / ☐ / ☐
Volunteer Recruitment / Have you had opportunities to recruit, support, or develop volunteers? / ☐ / ☐
Documentation / Are your requirements current upon review of the Requirement Checklist? / ☐ / ☐
AmeriCorps Matters / Have you scheduled time with your Site Supervisor for regular discussion? / ☐ / ☐
REQUIREMENT CHECKLIST EXPLANATION
Please provide explanations for any areas of noncompliance. Explain why compliance hasn’t been maintained, and explain the steps you are taking to correct this.
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OTHER FEEDBACK
Indicate, in detail, any other feedback that you would like to provide program staff and supervisors.
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