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Students Name (Required.)

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Internship Site (Required.)

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Site Supervisor’s Name (Required.)

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Will student have completed 200 hours by the end of internship? (Required.)

INSTRUCTIONS FOR COMPLETING EVALUATION

Below are categories that contain a number of traits, abilities, and characteristics that are important in measuring a successful internship experience. Carefully evaluate each quality and check the rating that best describes the student's current functioning level.

1 = Rarely displays characteristic

2 = Occasionally displays characteristic

3 = Ordinarily displays characteristic

4 = Regularly displays characteristic

5 = Consistently displays characteristic

NA = Not applicable
I. PERFORMANCE

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1. Establishes and plans work objectives. (Required.)

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2. Organizes work well. (Required.)

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3. Has concern for quality of work. (Required.)

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4. Displays ability to solve problems. (Required.)

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5. Displays capacity for motivating others. (Required.)

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6. Has ability to work independently. (Required.)

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7. Possesses strong communication skills. (Required.)

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8. Displays a marked capacity for work and production. (Required.)

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9. Is critical of own performance and quality of work. (Required.)

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10. Completes assignments on time. (Required.)

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11. Shows concern for safety of others. (Required.)

II. KNOWLEDGE

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12. Displays ability to integrate conceptual knowledge and activity skills. (Required.)

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13. Displays knowledge and understanding of program principles and methods. (Required.)

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14. Displays ability to apply knowledge in a practical way. (Required.)

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15.. Possesses and demonstrates expanding scope of interests. (Required.)

III. PERSONALITY AND ATTITUDE

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16. Shows enthusiasm for work. (Required.)

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17. Demonstrates initiative. (Required.)

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18. Displays creativity and imagination. (Required.)

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19. Displays average maturity for age. (Required.)

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20. Displays flexibility. (Required.)

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21. Is completely dependable. (Required.)

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22. Has self-confidence. (Required.)

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23. Gains respect of others. (Required.)

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24. Is sensitive to the needs of others. (Required.)

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25. Is tactful in relations with others. (Required.)

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26. Accepts suggestions, directions, and critical evaluation well. (Required.)

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27. Accepts assignments willingly. (Required.)

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28. Upholds and follows agency policies. (Required.)

IV. PERFORMANCE APPRAISAL

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A. Strengths: Describe the student’s outstanding abilities. (Required.)

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B. Suggestions for improvement: Describe the areas in which the student needs the greatest improvement. (Required.)

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Site Supervisor’s Evaluation for Employment (Required.)

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Evaluation was reviewed with student? (Required.)

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Evaluation was reviewed with instructor? (Required.)

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Site Supervisor’s Signature (please type name below) (Required.)

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Date (Required.)

Date
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 100% of survey complete.

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