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Mentorship Evaluation Instructions

Student: Print your full name, school and campus, and the start and end date of your course.
Student Name:
School: Campus:
Course Start Date: Course End Date:
Student Signature: Date:

The authorized mentorship placement site representative(s)[1] is asked to evaluate the student’s overall performance as satisfactory or unsatisfactory (“satisfactory” met placement expectation or “unsatisfactory” has not met placement expectations, as outlined later in this manual). The overall performance evaluation will be submitted to the CCA Program upon exam eligibility, as a permanent record of the satisfactory performance of the student at entry-level.

As displayed in the sample to the right, at the end of each mentorship placement, the placement site representative will:

  • Identify the authorized care hours the student spent at the placement site.
  • Identify the site location where the placement occurred.
  • Identify the student’s level of performance (“Satisfactory” or “Unsatisfactory”).
  • Provide the site representative’s name (print), title, phone number, and sign and date.

Identifying a student’s performance as “Satisfactory” indicates the student met the placement expectations.

Identifying a student’s performance as “Unsatisfactory” indicates the student did not met the placement expectations as outlined on page 2. Before a placement is signed off as “unsatisfactory”, a collaborative effort between relevant parties[2] will have been made to assist the student to gain the required competence. Failing a placement means the student is not eligible for the CCA Certification Exam. As a result of daily feedback and periodic evaluations, an unsatisfactory placement result should not be a surprise to the student or instructor.

The Overall Mentorship Performance Evaluation are copied by the education provider and submitted to the CCA Program with the Education Providers’ Final Evaluation as an appendix.


  1. Authorized Placement Site Representative is determined by placement site and can be the mentor, the mentor’s supervisor, or another person the placement site deems appropriate. The placement site may be contacted by the CCA Program Administration to verify the identity of the authorized placement site representative.
  2. Relevant parties include student, placement site, mentor and educator.

License

CCA Mentorship Competency Assessment Tool Copyright © 2022 by Nova Scotia Community College. All Rights Reserved.

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