<table style="width:100%;">
<colgroup>
<col style="width: 11%" />
<col style="width: 18%" />
<col style="width: 1%" />
<col style="width: 16%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 9%" />
<col style="width: 2%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 14%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="7" rowspan="2"><p><strong>U.S. Agency for International
Development</strong></p>
<p><strong>ANNUAL EVALUATION FORM – FOREIGN SERVICE</strong></p></td>
<td colspan="7">EVALUATION PERIOD (mm/dd/yyyy)</td>
</tr>
<tr class="even">
<td colspan="4">FROM      </td>
<td colspan="3">TO      </td>
</tr>
<tr class="odd">
<td colspan="14"><strong>SECTION 1 – ADMINISTRATIVE DATA</strong></td>
</tr>
<tr class="even">
<td colspan="5"><p>a. NAME (Last, First, MI)</p>
<p>     </p></td>
<td colspan="5"><p>b. SSN (Last 4 digits)</p>
<p>    </p></td>
<td colspan="4"><p>c. RANK/STEP</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="2"><p>d. POSITION AOSC TITLE</p>
<p>     </p></td>
<td colspan="6"><p>e. POSITION FUNCTIONAL TITLE</p>
<p>     </p></td>
<td colspan="5"><p>f. POST/USAID OFFICE</p>
<p>     </p></td>
<td><p>g. BACKSTOP</p>
<p>  </p></td>
</tr>
<tr class="even">
<td colspan="14">h. CAREER STATUS (Check appropriate box) - CAREER
CANDIDATE CAREER OTHER </td>
</tr>
<tr class="odd">
<td colspan="14"><strong>SECTION 2 – AUTHENTICATION OF FINAL ANNUAL
EVALUATION</strong></td>
</tr>
<tr class="even">
<td colspan="4"><p>a. NAME OF RATING OFFICIAL (Last, First, MI)</p>
<p>     </p></td>
<td colspan="8">SIGNATURE</td>
<td colspan="2">DATE</td>
</tr>
<tr class="odd">
<td colspan="4"><p>b. NAME OF AC CHAIRPERSON</p>
<p>     </p></td>
<td colspan="8">SIGNATURE</td>
<td colspan="2">DATE</td>
</tr>
<tr class="even">
<td colspan="4">c. EMPLOYEE: (Signature acknowledges receipt of
evaluation, not necessarily concurrence with evaluation)</td>
<td colspan="8"><p>SIGNATURE</p>
<p>EMPLOYEE DECLINES TO SIGN </p></td>
<td colspan="2">DATE</td>
</tr>
<tr class="odd">
<td colspan="14"><strong>SECTION 3 – FINAL ANNUAL EVALUATION PERFORMANCE
RESULTS</strong></td>
</tr>
<tr class="even">
<td colspan="14">a. EMPLOYEE MET ALL SKILL STANDARDS FOR HIS/HER CURRENT
CLASS: YES NO </td>
</tr>
<tr class="odd">
<td colspan="14">b. EMPLOYEE MET ALL WORK OBJECTIVES: YES NO </td>
</tr>
<tr class="even">
<td colspan="14"><p><strong>SECTION 4 – ROLE IN THE
ORGANIZATION</strong></p>
<p>Specify organizational setting, continuing responsibilities and
functions within operating unit, including resources managed</p></td>
</tr>
<tr class="odd">
<td colspan="14">     </td>
</tr>
<tr class="even">
<td>For Official Use Only</td>
<td colspan="2">Date Received by AMS/EXO                </td>
<td colspan="3">Employee Statement Attached: YES NO </td>
<td colspan="3"><p>Date Received</p>
<p>by HR      </p></td>
<td colspan="5"><p>Date Placed in Official</p>
<p>Evaluation Folder      </p></td>
</tr>
</tbody>
</table>

AID 461-1 (04/04) Page 1 of 4

+--------------------------------+---+--------+------------+---+----------+
| NAME (Last, First, MI)         | S |        | EVALUATION |   |          |
|                                | S |        | PERIOD     |   |          |
|                                | N |        | (m         |   |          |
|                                | ( |        | m/dd/yyyy) |   |          |
|                                | L |        |            |   |          |
|                                | a |        |            |   |          |
|                                | s |        |            |   |          |
|                                | t |        |            |   |          |
|                                | 4 |        |            |   |          |
|                                | d |        |            |   |          |
|                                | i |        |            |   |          |
|                                | g |        |            |   |          |
|                                | i |        |            |   |          |
|                                | t |        |            |   |          |
|                                | s |        |            |   |          |
|                                | ) |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
|                                |   |        | FROM       | T |          |
|                                |   |        |            | O |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| **SECTION 5 -- PERFORMANCE     |   |        |            |   |          |
| PLAN**                         |   |        |            |   |          |
|                                |   |        |            |   |          |
| Establish Performance Plan     |   |        |            |   |          |
| within 45 calendar days of the |   |        |            |   |          |
| beginning of the evaluation    |   |        |            |   |          |
| period                         |   |        |            |   |          |
|                                |   |        |            |   |          |
| 1 - 3 work objectives with 1 - |   |        |            |   |          |
| 2 performance measures for     |   |        |            |   |          |
| each work objective            |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| a\. PERFORMANCE PLAN           |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| **SECTION 5b -- AUTHENTICATION |   |        |            |   |          |
| OF PERFORMANCE PLAN**          |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| c\. NAME OF RATING OFFICIAL    |   | SIG    |            |   | DATE     |
| (Last, First, MI)              |   | NATURE |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| d\. NAME OF AC REPRESENTATIVE  |   | SIG    |            |   | DATE     |
| (Optional)                     |   | NATURE |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| e\. EMPLOYEE: (Signature       |   | SIG    |            |   | DATE     |
| acknowledges receipt of        |   | NATURE |            |   |          |
| performance plan, not          |   |        |            |   |          |
| necessarily concurrence with   |   | EM     |            |   |          |
| plan)                          |   | PLOYEE |            |   |          |
|                                |   | DE     |            |   |          |
|                                |   | CLINES |            |   |          |
|                                |   | TO     |            |   |          |
|                                |   | SIGN   |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| **SECTION 6 -- FORMAL          |   |        |            |   |          |
| MID-POINT PROGRESS REVIEW**    |   |        |            |   |          |
|                                |   |        |            |   |          |
| Includes any revisions to work |   |        |            |   |          |
| objectives and performance     |   |        |            |   |          |
| measures                       |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| a\. MID-POINT PROGRESS REVIEW  |   |        |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| **SECTION 6b -- AUTHENTICATION |   |        |            |   |          |
| OF FORMAL MID-POINT PROGRESS   |   |        |            |   |          |
| REVIEW**                       |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| c\. NAME OF RATING OFFICIAL    |   | SIG    |            |   | DATE     |
| (Last, First, MI)              |   | NATURE |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| d\. NAME OF AC REPRESENTATIVE  |   | SIG    |            |   | DATE     |
| (Optional)                     |   | NATURE |            |   |          |
|                                |   |        |            |   |          |
|                                |   |        |            |   |          |
+--------------------------------+---+--------+------------+---+----------+
| e\. EMPLOYEE: (Signature       |   | SIG    |            |   | DATE     |
| acknowledges receipt of        |   | NATURE |            |   |          |
| mid-point progress review, not |   |        |            |   |          |
| necessarily concurrence with   |   | EM     |            |   |          |
| review)                        |   | PLOYEE |            |   |          |
|                                |   | DE     |            |   |          |
|                                |   | CLINES |            |   |          |
|                                |   | TO     |            |   |          |
|                                |   | SIGN   |            |   |          |
+--------------------------------+---+--------+------------+---+----------+

AID 461-1 (04/04) Page 2 of 4

+---------------------------------+----------+-----------+------------+
| NAME (Last, First, MI)          | SSN      | E         |            |
|                                 | (Last 4  | VALUATION |            |
|                                 | digits)  | PERIOD    |            |
|                                 |          | (mm       |            |
|                                 |          | /dd/yyyy) |            |
+---------------------------------+----------+-----------+------------+
|                                 |          | FROM      | TO         |
|                                 |          |           |            |
+---------------------------------+----------+-----------+------------+
| **SECTION 7 -- ASSESSMENT OF    |          |           |            |
| PERFORMANCE, SKILLS AND         |          |           |            |
| POTENTIAL**                     |          |           |            |
+---------------------------------+----------+-----------+------------+
| a\. RATING OFFICIAL'S STATEMENT |          |           |            |
| ON PERFORMANCE, SKILLS AND      |          |           |            |
| POTENTIAL (For more             |          |           |            |
| information, see the EEP        |          |           |            |
| Guidebook, Chapter V. Preparing |          |           |            |
| & Completing the AEF)           |          |           |            |
|                                 |          |           |            |
|                                 |          |           |            |
+---------------------------------+----------+-----------+------------+

AID 461-1 (04/04) Page 3 of 4

+-------------------+---+----------+----------+---+---+----------+------------+
| NAME (Last,       |   |          | SSN      | E |   |          |            |
| First, MI)        |   |          | (Last 4  | V |   |          |            |
|                   |   |          | digits)  | A |   |          |            |
|                   |   |          |          | L |   |          |            |
|                   |   |          |          | U |   |          |            |
|                   |   |          |          | A |   |          |            |
|                   |   |          |          | T |   |          |            |
|                   |   |          |          | I |   |          |            |
|                   |   |          |          | O |   |          |            |
|                   |   |          |          | N |   |          |            |
|                   |   |          |          | P |   |          |            |
|                   |   |          |          | E |   |          |            |
|                   |   |          |          | R |   |          |            |
|                   |   |          |          | I |   |          |            |
|                   |   |          |          | O |   |          |            |
|                   |   |          |          | D |   |          |            |
|                   |   |          |          | ( |   |          |            |
|                   |   |          |          | m |   |          |            |
|                   |   |          |          | m |   |          |            |
|                   |   |          |          | / |   |          |            |
|                   |   |          |          | d |   |          |            |
|                   |   |          |          | d |   |          |            |
|                   |   |          |          | / |   |          |            |
|                   |   |          |          | y |   |          |            |
|                   |   |          |          | y |   |          |            |
|                   |   |          |          | y |   |          |            |
|                   |   |          |          | y |   |          |            |
|                   |   |          |          | ) |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
|                   |   |          |          | F |   |          | TO         |
|                   |   |          |          | R |   |          |            |
|                   |   |          |          | O |   |          |            |
|                   |   |          |          | M |   |          |            |
|                   |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| **SECTION 7 --    |   |          |          |   |   |          |            |
| ASSESSMENT OF     |   |          |          |   |   |          |            |
| PERFORMANCE,      |   |          |          |   |   |          |            |
| SKILLS AND        |   |          |          |   |   |          |            |
| POTENTIAL -       |   |          |          |   |   |          |            |
| CONTINUED**       |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| b\. 360 INPUT     |   |          |          |   |   |          |            |
| SOURCES (Check    |   |          |          |   |   |          |            |
| all that apply):  |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| EMPLOYEE'S        |   |          |          |   |   |          |            |
| SELF-ASSESSMENT   |   |          |          |   |   |          |            |
| CUSTOMERS         |   |          |          |   |   |          |            |
| MANAGERS PEERS    |   |          |          |   |   |          |            |
| SUBORDINATES AIF  |   |          |          |   |   |          |            |
| OTHERS            |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| c\. ADDITIONAL    |   |          |          |   |   |          |            |
| MANDATORY 360     |   |          |          |   |   |          |            |
| INPUT SOURCES FOR |   |          |          |   |   |          |            |
| THE FOLLOWING     |   |          |          |   |   |          |            |
| BACKSTOPS:        |   |          |          |   |   |          |            |
| CONTROLLERS,      |   |          |          |   |   |          |            |
| CONTRACT OFFICERS |   |          |          |   |   |          |            |
| AND LEGAL         |   |          |          |   |   |          |            |
| ADVISORS - ONLY   |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| RECEIVED 360      |   |          |          |   |   |          |            |
| INPUT FROM        |   |          |          |   |   |          |            |
| USAID/W (Check as |   |          |          |   |   |          |            |
| appropriate):     |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
| FINANCIAL         |   |          |          |   |   |          |            |
| MANAGEMENT        |   |          |          |   |   |          |            |
| PROCUREMENT       |   |          |          |   |   |          |            |
| GENERAL COUNSEL   |   |          |          |   |   |          |            |
| REQUESTED, BUT    |   |          |          |   |   |          |            |
| NOT RECEIVED      |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| d\. EVALUATION OF |   |          |          |   |   |          |            |
| WORK OBJECTIVES:  |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| WORK OBJECTIVE #1 | W |          |          |   | W |          |            |
|                   | O |          |          |   | O |          |            |
| MET NOT MET       | R |          |          |   | R |          |            |
|                   | K |          |          |   | K |          |            |
|                   | O |          |          |   | O |          |            |
|                   | B |          |          |   | B |          |            |
|                   | J |          |          |   | J |          |            |
|                   | E |          |          |   | E |          |            |
|                   | C |          |          |   | C |          |            |
|                   | T |          |          |   | T |          |            |
|                   | I |          |          |   | I |          |            |
|                   | V |          |          |   | V |          |            |
|                   | E |          |          |   | E |          |            |
|                   | # |          |          |   | # |          |            |
|                   | 2 |          |          |   | 3 |          |            |
|                   |   |          |          |   |   |          |            |
|                   | M |          |          |   | M |          |            |
|                   | E |          |          |   | E |          |            |
|                   | T |          |          |   | T |          |            |
|                   | N |          |          |   | N |          |            |
|                   | O |          |          |   | O |          |            |
|                   | T |          |          |   | T |          |            |
|                   | M |          |          |   | M |          |            |
|                   | E |          |          |   | E |          |            |
|                   | T |          |          |   | T |          |            |
|                   | N |          |          |   | N |          |            |
|                   | / |          |          |   | / |          |            |
|                   | A |          |          |   | A |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| **SECTION 8 --    |   |          |          |   |   |          |            |
| APPRAISAL         |   |          |          |   |   |          |            |
| COMMITTEE MEMBERS |   |          |          |   |   |          |            |
| AND COMMENTS**    |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| a\. APPRAISAL     |   |          |          |   |   |          |            |
| COMMITTEE MEMBER  |   |          |          |   |   |          |            |
| NAMES (Last,      |   |          |          |   |   |          |            |
| First, MI):       |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| 1\)               |   | 2\)      |          |   |   | 3\)      |            |
|                   |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+
| b\. APPRAISAL     |   |          |          |   |   |          |            |
| COMMITTEE         |   |          |          |   |   |          |            |
| COMMENTS (As      |   |          |          |   |   |          |            |
| appropriate):     |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
|                   |   |          |          |   |   |          |            |
+-------------------+---+----------+----------+---+---+----------+------------+

**Privacy Act Statement**: The following statement is required to be
attached to the subject form by the Privacy Act of 1974 (P.L. 93-579: 88
Statute 1896). This form is used to evaluate the performance of Foreign
Service and Senior Foreign Service employees. Disclosure of information
provided will not be made outside the Agency without written consent of
the employee concerned except: (a) pursuant to any applicable routine
use listed under USAID\'s Foreign Service Employee Personnel Records
System (USAID 1) in USAID\'s Notice of System of Records (available from
the Information and Records Division) for implementing the Privacy Act
published in the Federal Register, or (b) when disclosure without the
employee\'s consent is authorized by the Privacy Act and provided for in
USAID Regulation 15. The Social Security Number is provided voluntarily
by the individual to enable proper entry of this report into the
employee\'s records. Failure to provide the required information could
lead to mistaken identity entailing administrative complications with
possible inconvenient or adverse consequences for the employee.

**Confidentiality of Records:** This form is an efficiency report which
shall be subject to inspection only by those persons authorized by
Section 604 of the Foreign Service Act, 22 U.S.C. 4004.

AID 461-1 (04/04) Page 4 of 4