EVALUATION REPORT & COUNSELING RECORD



EVALUATION REPORT & COUNSELING RECORD

|1. Name (Last, First MI suffix) |2. Class Year |3. Company-PLT-SQD |

|4. Period of Report |5. Type of Report |

|Fall Winter Year |Regular Special |

|6. PFA/PFT Date |7. Ht/Wt |8. Swim Qualification |

| |WS NS |None 1st 2nd 3rd |

|9. Billet Assigned: |10. Major: |

|11. Awards / NROTC Extracurricular Activities: |

|12. Community Service Activities: |

|13. Date Midterm Counseling Completed |14. Name of Midterm Counselor |15. Signature of Individual Counseled |

|PERFORMANCE TRAITS: 1.0 – Below standards/not progressing or UNSAT in any one standard; 2.0 – Does not meet all 3.0 standards; 3.0 – Meets all 3.0 standards; 4.0 – |

|Exceeds most 3.0 standards; 5.0 – Meets overall criteria and most of the specific standards for 5.0. Standards are not all inclusive. (* Must be specifically |

|justified) |

|PERFORMANCE TRAITS |1.0* |2.0 |3.0 |4.0 |5.0 |

| |Below Standards |Progressing |Meets Standards |Above |Greatly Exceeds Standards |

|16. Equal Opportunity: |- Displays personal bias or | |- Always treats others with | |- Admired for fairness and human |

|Fairness, respect for |engages in harassment | |fairness and respect. | |respect. |

|Human Worth. |- Lacks respect for EO | |- Does not condone bias or | |- Ensures a climate of fairness and |

| |objectives. | |harassment in or outside the | |respect for human worth. |

| |- Interferes with order and | |battalion. | |- Leader and model contributor to unit |

| |discipline by disregarding rights| |- Positively contributes to unit | |cohesiveness and morale. |

| |of others. | |morale and cohesiveness. | | |

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|17. Organizational |- Creates conflict, unwilling to | |- Reinforces others’ efforts, | |- Team builder, inspires cooperation |

|Support: Contributions |work with others, puts self above| |meets personal commitments to | |and progress. |

|towards team building |team. | |team. | |- Talented mentor, focuses goals and |

|and team results. |- Fails to understand team goals | |- Understands team goals, employs| |techniques for team. |

|Communication skills. |or teamwork techniques. | |good teamwork techniques. | |- The best at accepting and offering |

| |- Does not take direction well. | |- Accepts and offers team | |team direction. |

| |- Finds excuses to get out of | |direction. | |- Volunteers for almost everything. |

| |battalion activities. | |- Will volunteer if asked to. | | |

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|18. Military Bearing/ |- Unsatisfactory demeanor or | |- Excellent personal appearance. | |- Exemplary personal appearance. |

|Appearance, Physical |conduct. | |- Excellent demeanor or conduct. | |- Exemplary personal demeanor or |

|fitness |- Consistently unsatisfactory | |- Complies with physical | |conduct. |

| |appearance. | |readiness program, within all | |- Excellent or outstanding PRT. A |

| |- Unable to meet one or more | |standards. | |leader in physical readiness. |

| |physical readiness standards. | | | | |

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|19. Character, Conduct: |- Fails to live up to Navy Core | |- Always lives up to Navy Core | |- Exemplifies Navy Core Values: Honor, |

|Adherence to Navy Core |Values: Honor, Courage, and. | |Values: Honor, Commitment, and | |Commitment, and Courage. |

|Values: Honor, Courage, |Commitment. | |Courage. | |- Personal behavior clearly marks |

|Commitment,. |- Frequently corrected due to | |- Always behaves correctly. | |midshipman as superior. |

| |inappropriate behavior. | | | | |

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EVALUATION REPORT & COUNSELING RECORD (cont’d)

|PERFORMANCE TRAITS |1.0* |2.0 |3.0 |4.0 |5.0 |

| |Below Standards |Progressing |Meets Standards |Above |Greatly Exceeds Standards |

|20. Mission |- Lacks initiative | |- Takes initiative to meet | |- Develops innovative ways to |

|Accomplishment, Academic|- Unable to plan or prioritize. | |goals. | |accomplish goals. |

|effort, Initiative: |- Fails to get the job done. | |- Plans/prioritizes | |- Plans/prioritizes with exceptional |

|Taking initiative, |- Sets unrealistic or | |effectively. | |skill and foresight. |

|planning, prioritizing, |unchallenging goals. | |- Always gets the job done. | |- Gets job done earlier and better than|

|and achieving goals. |- Academic achievement has caused| |- Academic achievement clearly | |expected. |

| |midshipman to receive a PRB | |demonstrates effort. | |- Sustained superior effort. |

| |(second consecutive offense). | | | |- Significant upward trend over |

| | | | | |previous semester. |

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|21. Leadership/ |- Fails to motivate, train, or | |- Effectively motivates, trains| |- Inspiring motivator and trainer. |

|Followership, |develop subordinates. | |and develops subordinates. | |- Superb organizer, great foresight, |

|Management: Organizing, |- Fails to organize, creates | |- Organizes successfully, | |gets ahead of problems. |

|Motivating, and |problems for subordinates. | |solves problems as they occur. | |- Perseveres through the toughest |

|Developing others to |- Lacks the ability to cope with | |- Performs well in stressful | |challenges. |

|accomplish goals |or tolerate stress. | |situations. | | |

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| 22. Comments on Performance (Rater) : |

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|Name of Rater: |

| 23. Comments on Performance (Senior Rater) : |

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|Name of Senior Rater: |

|24. Comments on Performance (Class Advisor) : |

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|Promotion Recommendation |

|Significant Problems |

|Progressing |

|Promotable |

|Must |

|Promote |

|Early |

|Promote |

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|Individual |

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|Summary |

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|Peer Score |

|Academic Term GPA       Cum. GPA       |

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|Aptitude Grade       |

|Signature of Class Advisor |

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|25. Signature of Commanding Officer |26. Signature of Midshipman Evaluated |

| |Statement provided |

Revised 12/2004

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