Sample End-of-Year Evaluation Form

Sample End-of-Year Evaluation Form

(Excerpted from The ACCESS Mentor Training Manual. Used with permission from the Mentor Coordinator Network, Grand Rapids, Michigan.)

Family:                                                       

Team/Congregation:
 
 
Part I: Family Progress
I. Housing—Family has stable and adequate housing
0=    Family has inadequate housing situation
1=    Family has moved into adequate housing & has no eviction or shut off notices
2=    Family has been in stable/adequate housing for at least 3 months
3=    Family has been in stable/adequate housing for at least 6 months
 Score:
 
2. Employment—Family has achieved stable employment
0=    Family has no employment
1=    Family has maintained employment for minimum of 1 month at          hrs/wk
2=    Family has maintained employment for a minimum of 3 months at        hrs/wk
3=    Family has maintained employment for at minimum of 6 months at         hrs/wk
Score:
 
3. Progress towards goals
0=    Family has made no progress towards any of their goals
1=    Family has achieved one of their goals
2=    Family has achieved two of their goals
3=    Family has achieved three of their goals
Score:
 
4. Financial—Family has developed and maintained a feasible budget
0=    Family does no budget planning
1=    Family has recently developed a workable budget
2=    Family has developed and adhered to working budget for at least 3 months
3=    Family has developed and adhered to a working budget for at least 6 months
Score:
 
5. Child Care Planning—Family has flexible options for ongoing childcare
0=    Family has inconsistent or no childcare plan or options in place
1=    Family has recently developed a workable, multi-optioned childcare plan
2=    Family has adequate, multi-optioned childcare plan in place for 3 months
3=    Family has adequate, multi-optioned childcare plan in place for 6 months
Score:
 
6. Transportation—Family has reliable transportation
0=    Family has no access to reliable transportation
1=    Family only has access to public transportation and/or family & friends
2=    Family has had access to reliable personal transportation for at least one month
3=    Family has had access to reliable personal transportation for at least three months
Score:
 
 
7. Assertiveness—Family follows through on goals, meetings & communication
0=    Family avoids volunteers—frequently absent or fails to call or respond
1=    Some follow through but is inconsistent or limited
2=    Family consistently responds to volunteer initiation of meetings or events
3=    Family initiates meetings and is assertive in sharing concerns, questions, etc.
Score:
 
8. Crisis/Emergency Support System*
0=    Family has no emergency support/back-up system in place
1=    Family has recently identified contact person(s) for emergency support
2=    Family has established contact person(s) in place for at least 3 months
3=    Family has established contact person(s) in place for at least 6 months
Score:
 
9. Family Self Assessment of Progress
0=    Family indicates they made little or no progress
1=    Family indicates they made some progress
2=    Family indicates they made quite a bit of progress
3=    Family indicates they made very significant progress
Score:
 
10. Other (food, clothing, education/training, medical, or other areas of family concern—add as needed)
0=
1=
2=
3=
Score:
Total Score:
 
Please check one of the following:
0-15 points= unsuccessful closure
16-20 points= moderately successful
21-25 points= highly successful
26+ points= very successful closure
 
*this may be a current team member, neighbor or friend, this person(s) will provide support for the foreseeable future.
 
 
Part II: Team Development
 
Volunteers have:
1. Reported a positive experience with the family support process   YES         NO
2. Developed family empowerment skills YES   NO
3. Established leadership and team member roles      YES   NO
4. Developed positive relationships with family members   YES    NO
5. Received congregational support for activities       YES   NO
 
Comments:
 
Part III: Spiritual Development (for organizational or congregational feedback only. These questions are not designed to determine success or failure of family).
 
1. Family has demonstrated indications of faith development:
. Voluntarily inquired into spiritual issues       YES   NO
. Expressed interest in attending church/congregation  YES       NO
. Expressed interest in spiritual disciplines such as prayer & study  YES         NO
. Family has stated that they are not interested in spiritual issues  YES         NO
 
Comments:
 
 
2. Volunteers have reported spiritual growth as a result of ministry experience.  YES NO
Comments:
 
 
3. Volunteers are interested in future involvement with another family
Comments:
 
Program Coordinator:
Date: