Student’s Name
Intern/Practicum Supervisor’s Name
Name of Organization
Review Date
Please indicate on the scale below your self-evaluation on the traits listed.
5=Outstanding 4=Good 3=Average 2=Mediocre 1=Poor 0=No Opinion
| Traits |
5 |
4 |
3 |
2 |
1 |
0 |
| Promptness |
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| Dependability |
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| Professional Appearance |
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| Initiative |
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| Maturity |
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| Self-Confidence |
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| Time Management |
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| Written Communication Skills |
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| Oral Communication Skills |
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| Ability to Work with Others |
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| Acceptance of Criticism |
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| Overall Performance |
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- Did your supervisor(s) provide you with learning opportunities or make an adequate effort to train you?
- Did you feel satisfied with the variety and nature of experiences of your internship/practicum? Explain.
- What do you consider the most beneficial aspect of this internship/practicum?
- What do you consider the least beneficial aspect of this internship/practicum?
- Would you recommend that this company be retained as a participant in the internship/practicum program? Explain.
- What recommendation(s), if any, would you offer to students who might be interested in this field as a career?
- Do you have any suggestions that would improve the internship/practicum program?
Student’s Signature ____________________________________ Date _________
