Page 16 - faculty manual 2020-2021

Appendix A:
GEORGETOWN AMERICAN UNIVERSITY
SCHOOL OF MEDICINE

STUDENT MID-TERM OR MID-COURSE EVALUATION FORM

This form should be completed by faculty members for the evaluation of a student's academic
performance.

Student’s name: _______________________ Student’s ID #: ____________________ Class:
__________________

Considering the domains of (tick appropriate domain):
____ Premedical Knowledge

____ Basic Medical Knowledge

____ Clinical Skills

____ Professionalism
____ Others (please specify) __________________________________

This student's STRENGTHS are:

This student NEEDS TO WORK AND IMPROVE ON:

Overall, this student's progress to date is:

___ Satisfactory
___ Unsatisfactory

Recommendation
___ This student should meet with a guidance counselor (Student should take this form to the guidance
counselor)

___ This student don't have to meet with a guidance counselor (Student save this form as a personal copy)

Evaluator’s name: ____________________ Signature: _____________________ Date: ______________

15 Last updated 8/25/2020