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 | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Dependability | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Professional Appearance | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Initiative | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Maturity | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Self-Confidence | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Time Management | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Written Communication Skills | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Oral Communication Skills | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Ability to Work with Others | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Acceptance of Criticism | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
| Overall Performance | ( ) | ( ) | ( ) | ( ) | ( ) | ( ) |
- 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 _________