Instructions to the intern: This evaluation form is to be completed at the end of the internship experience by the work site supervisor. If you have more than one supervisor, you may complete multiple evaluations, but only one is required. The intern is to fill in the objectives from the training plan and give to the supervisor at least one week prior to the completion of the internship. After the intern and supervisor have reviewed and signed, return to the Internship Director by fax (308-865-8976) or scan and email.
Intern Name_______________________________Date___________________
Supervisor Name________________________Company___________________
Brief Description of Assignments Given to Intern
____________________________________________________________
____________________________________________________________
____________________________________________________________
| Training Plan Objectives. Rate the performance on each of the objectives listed on the Intern's Training Plan using the following scale: |
5
Outstanding |
4
Good |
3
Average |
2
Fair |
1
Unsatisfactory |
0
No Experience |
- ____________________________ 5 4 3 2 1
Comments
- ____________________________ 5 4 3 2 1
Comments
- ____________________________ 5 4 3 2 1
Comments
- ____________________________ 5 4 3 2 1
Comments
- ____________________________ 5 4 3 2 1
Comments
Work Performance Evaluation
5
Outstanding |
4
Good |
3
Average |
2
Fair |
1
Unsatisfactory |
0
No Experience |
Productivity |
| Volume of work |
|
5 4 3 2 1 0 |
| Quality of work |
|
5 4 3 2 1 0 |
| Steadiness |
|
5 4 3 2 1 0 |
| Knowledge of work |
|
5 4 3 2 1 0 |
| Interest in work |
|
5 4 3 2 1 0 |
| Attention to detail |
|
5 4 3 2 1 0 |
| Organizing efficiently |
|
5 4 3 2 1 0 |
Business Techniques |
| Meeting People |
|
5 4 3 2 1 0 |
| Working harmoniously |
|
5 4 3 2 1 0 |
| Telephone techniques |
|
5 4 3 2 1 0 |
| Following instructions |
|
5 4 3 2 1 0 |
| Accepting criticism |
|
5 4 3 2 1 0 |
| Oral communication |
|
5 4 3 2 1 0 |
| Written communication |
|
5 4 3 2 1 0 |
| Listening |
|
5 4 3 2 1 0 |
| Relationship to Supervisor |
|
5 4 3 2 1 0 |
| Relationship with Co-workers |
|
5 4 3 2 1 0 |
Personal |
| Appearance/Dress |
|
5 4 3 2 1 0 |
| Initiative |
|
5 4 3 2 1 0 |
| Tact |
|
5 4 3 2 1 0 |
| Accuracy |
|
5 4 3 2 1 0 |
| Judgment |
|
5 4 3 2 1 0 |
| Patience |
|
5 4 3 2 1 0 |
| Creativity |
|
5 4 3 2 1 0 |
| Self-Confidence |
|
5 4 3 2 1 0 |
| Cooperation |
|
5 4 3 2 1 0 |
| Flexibility |
|
5 4 3 2 1 0 |
| Dependability |
|
5 4 3 2 1 0 |
| Leadership |
|
5 4 3 2 1 0 |
| Motivation |
|
5 4 3 2 1 0 |
| Tolerance for stress |
|
5 4 3 2 1 0 |
| Independence |
|
5 4 3 2 1 0 |
| Willingness to Work |
|
5 4 3 2 1 0 |
Summary of Work Performance Evaluation: Please comment on strengths and weaknesses in relation to the above traits.
Recommendations: Please indicate course work or types of experiences that would improve the student's potential.
If contacted as a reference, what would your comments be regarding this intern?
Would you be interested in having another intern from our program?
Would you be interested in serving on an Advisory Council? Y N
Would you be interested in being a guest lecturer in one of our classes or making a presentation to our student organization? Y N
If so, what topic would you be most interested in discussing?
Additional Comments:
Signature of Supervisor____________________ Date _______________________
I have read the final evaluation and my supervisor has reviewed it with me.
Signature of Student ______________________ Date _______________________
Final Evaluation of Intern by Work Site Supervisor
Internship Manual (rev. 10/05) Page 33-35