Teacher Discussion Forums

I'm trying to come up with an effective evaluation form for students to assess their teacher. I usually distribute a bilingual version of this in my own adult classes 1/2 way through the term. I'm pretty satisfied with this but if anyone has any input, I'd love to hear from you:

Ratings:
#1 = Excellent;
#2 = Very good;
#3 = Good;
#4 = Just OK;
#5 = Poor

How well does your teacher...
a) prepare for class ............................................................................#
b) review/recycle previous weeks' language that we'd otherwise forget.....#
c) tell us what we're going to learn at the beginning................................#
d) make lessons interesting with a variety of activities, topics .................#
e) teach us at our level (not too hard, not too easy)..............................#
f) correct us (without interrupting or embarrassing us ).....................#
g) speak slow and clear enough for us to understand ............................#
h) explain things so we can understand.................................................#
i) give us as much speaking practice as possible....................................#
j) not waste time with reading/writing if it's a speaking/listening class......#
k) make sure we can all use the new words and grammar........................#
l) give us listening comprehension tasks................................................#
m) help us turn our receptive* into expressive* language.......................#
n) know what is difficult for us and what is easy....................................#
o) encourage us (to encourage each other) .........................................#
p) give us feedback on our progress....................................................#
q) tell me what my strengths/weaknesses are and how to improve..........#
r) ...(Am I missing something?)........................................................#

*receptive language: I understand it but forget to use it, or, I'm not sure when/how to use it.
*expressive language: I understand it completely and use it.

Does it have a comment section to elicit items they want to study? Often students won't speak up when you ask them but later on they might be more willing to write down topics and so forth they are interested in.

I think a teacher assessment form is a damn good idea. I may make one up for myself this term.

Or just steal yours.

Room for comments? Well, with a condensed font, additional space after each line (allowing for translation), there'd be lots of space for comments on the right.

Any ideas on including a (student) self-evaluation questions such as:
How satisfied am I with my own personal progress in this course? .............#
If not, why not?
[initial (placement), mid-term and final test recordings would be an invaluable for this.]

My previous form included the question:
Do you (have time to) review between classes? How much time? ________