Intern's Name: _____________________________
Date: ________________________
Agency Evaluator: __________________________
Agency: ______________________
Please Circle (10 being highest)
| 1. |
Willingness to perform job function |
1 2 3 4 5 6 7 8 9 10 N/A |
| 2. |
Interaction with agency personnel |
1 2 3 4 5 6 7 8 9 10 N/A |
| 3. |
Rapport with outside agencies and professionals |
1 2 3 4 5 6 7 8 9 10 N/A |
| 4. |
Student handles oneself in a professional manner |
1 2 3 4 5 6 7 8 9 10 N/A |
| 5. |
Executes work duties efficiently |
1 2 3 4 5 6 7 8 9 10 N/A |
| 6. |
Adapts to rules and procedures of the agency |
1 2 3 4 5 6 7 8 9 10 N/A |
| 7. |
Follows instructions of supervisors |
1 2 3 4 5 6 7 8 9 10 N/A |
| 8. |
Ability to relate to clients |
1 2 3 4 5 6 7 8 9 10 N/A |
| 9. |
Verbal communication |
1 2 3 4 5 6 7 8 9 10 N/A |
| 10. |
Ability to learn responsibilities and job duties |
1 2 3 4 5 6 7 8 9 10 N/A |
| 11. |
Quality of written work |
1 2 3 4 5 6 7 8 9 10 N/A |
| 12. |
Skill in integrating education knowledge with practical application |
1 2 3 4 5 6 7 8 9 10 N/A |
| 13. |
Student self-reliance and use of initiative |
1 2 3 4 5 6 7 8 9 10 N/A |
| 14. |
Personal confidence |
1 2 3 4 5 6 7 8 9 10 N/A |
| 15. |
Students ability to make decisions and judgments |
1 2 3 4 5 6 7 8 9 10 N/A |
| 16. |
Attitude--application to work |
1 2 3 4 5 6 7 8 9 10 N/A |
| 17. |
Quality of work |
1 2 3 4 5 6 7 8 9 10 N/A |
| 18. |
Student's areas of strength: |
| 19. |
Any areas needing improvement: |