Tutor Feedback Form

If you are a Personal Tutor with Literacy Network, you are required to submit regular feedback on your match. This form is helpful in many ways. The information you include is critical for us as we communicate with funders to justify their investment. The feedback on your match allows us to provide support to help your match succeed. The notes you include can also be great information to look back on to keep you and your learner inspired by your progress.
We do read your feedback within a few days of receiving it and will follow-up as indicated. Please call if you need immediate assistance.

Please complete all required fields.

Meeting Month

Year

Pair Type ESL Basic Literacy Citizenship

Tutor:

Learner:

How many times did you meet this month?

Approximately how many hours per meeting?

Add any new contact information for you or your learner here. (specify whose)

Check if your lessons were interrupted due to no-shows, illnesses, vacations or other problems.  Yes  No

General Literacy Skills Please check off items achieved in the past month. Add any details in the next area.  Spoke English with more confidence  Wrote in English with more confidence  Improved grammar in English  Improved English listening comprehension  Improved English reading comprehension  Learned new words in English  Improved pronunciation  Kept a reading log  Filled out form

Did you accomplish any other general literacy goals this month (speaking, listening, writing, reading)? Be as general or as specific as you wish!

Employment Please check off items achieved in the past month. Add any details in the next area.  Got a job (or a better job)  Received promotion at current job  Spoke with supervisor in English  Spoke with co-workers in English  Used written English at work  Read documents in English at work  Achieved goal on project at work  Given new responsibilities at work  Understood workplace better

Have you and your learner accomplished an employment-related goal not listed here?

Education Please check off items achieved in the past month. Add any details in the next area.  Got GED or HSED  Passed individual GED test  Improved score on individual GED test  Met with a counselor to start post-secondary program  Took a test to start studying in a new program  Started a new college or certificate program

Have you and your learner accomplished an education-related goal not listed here?

Community Involvement Please check off items achieved in the past month. Add any details in the next area.  Went to public library for the first time  Learned about how to become a U.S. citizen  Became an American citizen  Registered to vote  Voted  Got a driver's license  Used English more in the community

Have you and your learner accomplished a goal related to their involvement in the community goal not listed here? (e.g., volunteered, joined a club, etc.)

Financial Literacy Please check off items achieved in the past month. Add any details in the next area.  Learned to say and write numbers in English  Understood American money  Used forms and services at bank (deposit, withdrawal, etc.)  Balanced checkbook or wrote personal check  Compared prices and bargains or figured out how much individual items cost  Made a personal budget (planned for saving and spending money)  Understood difference between paying with cash and credit  Stopped using public assistance  Understood lease and rental agreements for apartment or learned about rights as tenant  Understood warranties for things purchased  Spoke with customer service on phone or in person

Have you and your learner accomplished a goal related to financial literacy not listed here?

Health Literacy Please check off items achieved in the past month. Add any details in the next area.  Learned names of body parts  Filled out patient form at clinic  Described health symptoms with confidence to doctors, nurses, or pharmacists  Understood patient rights at hospital or clinic  Learned about healthy habits (diet, exercise, nutrition; cessation of smoking or drug use)  Understood prescription medicines better

Have you and your learner accomplished a goal related to health literacy not listed here?

Involvement with child's education and general literacy Please check off items achieved in the past month. Add any details in the next area.  Read to child  Helped child with schoolwork  Spoke with child's teacher  Wrote a note to child's teacher  Visited library with child (or for child)

Have you and your learner accomplished a goal related to their child's literacy not listed here?

On a scale of 1-5, how would you rate your match?  1 - very negative  2 - not great  3 - OK  4 - pretty good  5 - Great!

Do you think the learning partnership is a positive experience for both of you?

Any other questions, concerns or problems about your match?

Do you have any suggestions for topics of future in-service training?

Have you and your learner accomplished a goal not listed above? Whether it is major (earning a driver's license, etc.) or more modest, please tell us here!

Do you want us to contact you about anything (on this form or not)?  Yes

Are you getting the Tutor Tips messages from Brian on a regular basis? If not, check the box to add yourself to the Tutors mailing list to stay in the loop!  Literacy Network personal tutors

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