Name of Student:  
Completed By:  
Name of School:  
Position:  

In order to assess the impact and effectiveness of the Phoenix course for those students who have successfully completed the scheme, we need to obtain feedback from you. This information will be used as a marker to monitor the student at three and six months. Your time in completing this is appreciated.

Interest: <Please select> Not very interested Average interest Keen Very keen  

Effort: <Please select> Does not try Consistent Good effort Outstanding  

Respect: <Please select> Poor Requires improvement Good effort Outstanding  

Learning Ability: <Please select> Very slow Learns slowly Fairly quick Rapid  

Communication: <Please select> Poor Fair Good Excellent  

Observation / Listening: <Please select> Not attentive Has difficulty Good Excellent  

Relationships with teachers: <Please select> Not co-operative Has difficulty Manages well Co-operative  

Relationships with friends: <Please select> Withdrawn Has difficulty Relates well Very popular  

Initiative: <Please select> Limited Fair Good Excellent  

Punctuality: <Please select> Limited Fair Good Excellent  

What do you feel the student gained most from Phoenix - has their behaviour/attitude changed in any way? (500 characters)