Alternate Instruction Evaluation Form
Student: _____________________________________________________________
Area of Instruction: _____________________________________________________
Instructor of Off-Campus activity: __________________________________________
Form to be completed by the Off-Campus Instructor: ___________________________
Objectives of Off- Campus Instruction:
Dates Instruction took place: ___________________ to ___________________
Length of each lesson: ___________________________________________________
Total number of lessons: ___________________
Attendance:
Tardy __ times
Absent __ times
Recommended numerical grade: _____
Please use the back of this sheet for any additional comments you may wish to make.
Instructor’s Signature: ___________________________________________________
Date: ___________________
Please return this form to Director of Physical Education, Shaker High School, Latham, New
York 12110.
Note: Prior Exhibit, 5125.3(h)