EVALUATION REPORT AND COUNSELING RECORD
2. RANK/CLASS
3. COMPANY-PLT-SQD
MIDN 4/C
4. OCCASION FOR REPORT
5. DATE OF REPORT
6. TYPE OF REPORT
REGULAR
SPECIAL
FALL
SPRING
OTHER
1. NAME (LAST, FIRST MI)
7a. PRT/PFT
DATE:
NAVY PRT SCORE:MAXIMUM
MARINE PFT SCORE:
10a. DUTY ASSIGNED
7b.
HEIGHT/WT
8. SAIL QUALIFIED
NONE
WS
NS
A
9. SWIM QUALIFIED
B
NONE
DATE:
10b. FIELD OF STUDY
1ST
2ND
3RD
11. AWARDS/HONORS
BLOCKS 12, 13, AND 14 FOR MIDTERM COUNSELING USE
12. DATE COMPLETED
13. COUNSELOR’S TYPED NAME
14. MIDSHIPMAN’S SIGNATURE
PERFORMANCE TRAITS: 1.0 – BELOW STANDARDS/NOT PROGRESSING OR UNSAT IN ANY ONE CRITERIA; 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 SPECIFIC STANDARDS FOR 5.0
PERFORMANCE
TRAITS
1.0*
BELOW
STANDARDS
2.0
PROGRESSING
3.0
MEETS
STANDARDS
4.0
ABOVE
STANDARDS
5.0
EXCEEDS
STANDARDS
15.
-EQUAL
OPPORTUNITY:
FAIRNESS,
RESPECT FOR
HUMAN WORTH
-Displays personal
bias/engages in
harassment.
-Lacks respect for
EO objectives
-Interferes with order
and discipline.
-
-Treats others with
fairness and respect.
-Does not condone bias
or harassment.
-Contributes to unit
morale and
cohesiveness.
-
-Exhibits exemplary
fairness and respect
-Prevents bias and
harassment in unit.
-Leader in improving
unit morale and
cohesiveness.
-Creates conflict,
unwilling to work
with others.
-Does not take
direction well.
-Makes excuses.
-
-Reinforces others,
meets personal
commitments.
-Understands team
goals and teamwork
techniques.
-Will volunteer if asked
to.
-
-Team builder.
-Talented mentor.
-Most capable at
accepting and
offering direction.
-Volunteers for
almost everything.
-Unsatisfactory
demeanor/conduct.
-Consistently
unsatisfactory
appearance
-Unable to meet one
or more physical
readiness standards.
-
-Excellent personal
appearance.
-Excellent demeanor or
conduct.
-Complies with physical
readiness program,
within all standards.
-
-Exemplary personal
appearance and
conduct.
-Excellent or
outstanding PFA/
PFT.
-Leader in physical
readiness.
-Fails to live up to
Navy Core Values.
-Frequently corrected
due to inappropriate
behavior.
-
-Lives up to Navy Core
Values.
- Always behaves
appropriately.
-
-Exemplifies Navy
Core Values.
-Personal behavior
clearly marks
midshipman as
superior.
MIDTERM
NOB
16.
-ORGANIZATIONAL SUPPORT:
CONTRIBUTES TO
TEAM BUILDING
AND TEAM
RESULTS
MIDTERM
NOB
17.
-MILITARY
BEARING,
APPEARANCE,
AND PHYSICAL
FITNESS
MIDTERM
NOB
18.
-CHARACTER,
CONDUCT, AND
ADHERENCE TO
NAVY CORE
VALUES
MIDTERM
NOB
19.
-MISSION
ACCOMPLISHMEN
T/ ACADEMIC
ACHIEVEMENT
MIDTERM
NOB
20.
-LEADERSHIP/
FOLLOWERSHIP:
MANAGEMENT
AND
SUBORDINATE
DEVELOPMENT
SKILLS
-Lacks initiative
-Unable to plan or
prioritize.
-Academic
achievement has
caused midshipman
to receive a PRB
(second consecutive
offense).
-
-Takes initiative to meet
goals.
-Plans/ prioritizes
effectively.
-Reliable.
-Academic achievement
clearly demonstrates
effort.
-
-Develops innovative
ways to accomplish
goals.
-Plans/ prioritizes
with exceptional skill
and foresight.
-Gets job done
earlier, better than
expected.
-Fails to motivate,
train, or develop
subordinates.
-Fails to organize,
creates problems for
subordinates.
-Lacks the ability to
cope with or tolerate
stress.
-
-Effectively motivates,
trains, and develops
subordinates.
-Organizes; solves
problems as they occur.
-Performs well in
stressful situations.
-
-Inspiring motivator
and trainer.
-Superb organizer,
great foresight, gets
ahead of problems.
-Perseveres through
the toughest
challenges.
MIDTERM
NOB
21. GROWTH POTENTIAL: BELOW
PROGRESSING
STANDARDS
MEETS
STANDARDS
ABOVE
STANDARDS
EXCEEDS
STANDARDS
22. BILLET RECOMMENDATION:
23. COMMENTS (PRIMARY GRADER IS
24. COMMENTS (SECONDARY GRADER IS
):
):
25. ADVISOR COMMENTS:
Class Rank:
27. INSTRUCTOR SIGNATURE
28. SIGNATURE OF MIDSHIPMAN EVALUATED
29. XO Signature
30. CO Signature
STATEMENT PROVIDED