Mid Term Review FormTheme Year Field Placement 
(This form is to be completed and returned to CCS Staff by February 1.)
Student:
Placement:
Theme Year: 
Date: 

1. What have been the major areas of new learning in the past four months?
Student Comments:

Review Team Comments:

2. What work has been related  to identified learning goals?
Student Comments:

Review Team Comments:

3. How would you describe the comfort level of working in this situation?
Student Comments:

Review Team Comments:

4. In what areas would be helpful to have more experience, practice and/or work? 
Student Comments:

Review Team Comments:

5. What have been some new learnings in the areas related to the Theme Year?
	Student Comments:

	Review Team Comments:

6. Where and how is theological reflection happening?
Student Comments:

Review Team Comments:

7. Are there changes in the placement that might be helpful with regard to:
	Student Comments	Review Team Comments	

-	areas and/or levels of responsibility?	

		
-	learning goals?	

		
-	support, feedback and direction from facilitator?	

		
-	from mentor?	

		
-from local committee?	

		

			Name				Signature			Date

Student:	__________________________________________________________

Recorder:	__________________________________________________________