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COOPERATIVE EDUCATION

GRADE REPORT WORKSHEET

Date of Grade Report:___________________________________________________________

Student Name:__________________________________________________________________

Last                                                  First                                                  MI.

Curriculum Program:____________________________________________________________

Course number ______________ Section ______    Semester:_____________

Employer_____________________________________________________________________

Supervisor ____________________________________________________________________

Employer Address ______________________________________________________________

Faculty Coordinator _____________________________________________________________

1.       Attendance (Total Hours Worked) Assessment:                 ­­­­­­­­­­­­­­­­­­­­­________________
2.      On-Site Evaluation Assessment (if conducted)                  ________________
3.       Mid-term Evaluation Assessment:   (if conducted)          ________________
4.      MLO 1 Assessment:                                                        ________________
5.       MLO 2 Assessment (if applicable):                                 ________________
6.        MLO 3 Assessment (if applicable):                                 ________________
7.      Employer Evaluation:                                                      ________________
8.      Student Self-evaluation Assessment:                                  ________________
9.        Faculty Coordinator Assessment:                                ________________

FINAL COURSE GRADE  ________________

Comments:

___________________________________________________   _________________

Faculty Coordinator Signature                                                        Date

Civil Rights and Non Discrimination Statement

It is the policy of the Virginia Community College System and Mountain Empire Community College to provide equal employment and educational opportunities for all persons without regard to race, color, religion, national origin, political affiliation, veteran status, gender, age, or sexual orientation and for all otherwise qualified persons with disabilities. This policy permits appropriate employment preference for veterans. This institution promotes and maintains educational opportunities without regard to race, color, sex, ethnicity, religion, gender, age (except when age is a bona fide occupational qualification), disability, national origin, or other non-merit factors.  This institution prohibits sexual harassment including sexual violence.

The following person has been designated to handle inquiries regarding non-discrimination policies: Ron Vicars, Vice President of Financial and Administrative Services. The following person has been designated to handle inquiries regarding student misconduct or equity issues based on gender: Lelia Bradshaw, Dean of Student Services. The following person has been designated to handle inquiries regarding employee misconduct or equity issues: Pam Giles, Human Resource Manager. For more information, contact 276.523.2400, 3441 Mountain Empire Rd., Big Stone Gap, VA, 24219. Virginia relay users dial 711.