Check in three times during the year

This form is used at three points during the year: 12-weeks into the program, at mid-year, and at the end of the year. Use this form in two different ways:

• Rate members' performance on different criteria
• Suggest future development and growth

This sample member evaluation was created by Illinois Public Health (Springfield, IL), an AmeriCorps*State program that supports health and community preparedness projects and conducts community outreach across the state.