Internship Evaluation Form Student Name(Required) Major/Minor Degree(Required) Student Email(Required) Organization Site Name & Location(Required) Supervisor Name(Required) Supervisor Phone #(Required)Internship/Experience Start Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920End Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student's Position Title(Required) Total Hours Completed(Required)Please rate the following aspects of your internship experience on the basis of this scale: 1) Unsatisfactory (Unacceptable - does not meet the minimum expectations) 2) Fair (Seldom demonstrates this ability/rarely meets expectations) 3) Good (Sometimes demonstrates this ability/meets expectations) 4) Exceptional (Always demonstrates this ability/consistently exceeds expectations) NA) Not Applicable to this internship experience.Attendance/Punctuality(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Appearance(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Communication skills(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Ability to follow directions(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Teamwork(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Social interaction(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Completion of assigned tasks(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Quality of work(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Cooperation(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Problem solving(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Creativity(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Initiative(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Computer skills(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Stress management(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Professional behavior & attitude(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable Self-motivated approach to work(Required) 1) Unsatisfactory 2) Fair 3) Good 4) Exceptional NA) Not Applicable CommentsNote to student: You are responsible for submitting this form to your supervisor during your initial meeting. Failure to do so may result in a delay of completion of the graduation requirement. Please remember to keep track of your schedule and hours. Note to supervisor: We appreciate your time and investment in our students. Please complete and return this form via email when student has completed his/her work internship experience. Please contact us if you have any questions, concerns, or would like to discuss anything regarding our students.Intern's Signature DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Supervisor's Signature(Required) Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Δ
