Appendix G
CHECK POINT EVALUATION FORM

1. My present interest in the LBS/OBS program is best described as
  graphic checkbox High   graphic checkbox Moderate   graphic checkbox Fading   graphic checkbox In trouble
   
2. My program progress to date is best described as
  graphic checkbox Faster than planned   graphic checkbox On track   graphic checkbox Slower than planned
   
3. My attendance to date is best described as
  graphic checkbox Acceptable 80% or better   graphic checkbox Border line 70%   graphic checkbox Below 60%
   
4. My progress and success to date is due to the following: (Check all the items that apply to you.)
 
graphic checkbox The training offered in Program Readiness graphic checkbox Program support(s)
graphic checkbox Faculty support graphic checkbox Early success
graphic checkbox Family support graphic checkbox Staff support
graphic checkbox Personal discipline graphic checkbox Agency support
graphic checkbox A manageable routine graphic checkbox A strong desire to succeed
graphic checkbox Previous level of schooling graphic checkbox Homework
graphic checkbox Minimal stress and anxiety  

Other___________________________________________________________________
   
5. My program would continue to be successful or it would improve if the following
action(s) were taken. (Check all of the actions you are interested in discussing.)
 
graphic checkbox A new timetable graphic checkbox Fewer hours in the program
graphic checkbox More hours in the program graphic checkbox A leave of absence
graphic checkbox A tutor graphic checkbox A different goal
graphic checkbox Better work habits graphic checkbox Improved punctuality
graphic checkbox More focus graphic checkbox More direction/help
graphic checkbox Counselling  

Other___________________________________________________________________
   
6. The following is affecting my performance and effort in the LBS/OBS program. (Check all the items that apply to you.)
 
graphic checkbox My health graphic checkbox A family member's health
graphic checkbox Job expectations graphic checkbox Financial pressures
graphic checkbox Personal problems graphic checkbox Medical drugs
graphic checkbox Time management graphic checkbox Family obligations
graphic checkbox Lack of support graphic checkbox Sponsor pressures
graphic checkbox Peer pressure  

Other___________________________________________________________________
   
7. Check one of the following statements as the closest to how you feel about your LBS/OBS commitment to date.
  graphic checkbox The work is manageable, the progress is satisfactory and my goal still appears achievable.
  graphic checkbox I'm not getting much work done, the progress is slower than what I would like and achieving my goal is not a sure thing.
  graphic checkbox I can't get the work done, there's hardly any progress and I'm thinking of dropping out.


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