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* Students Name

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* Internship Site

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* Site Supervisor’s Name

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* Will student have completed 200 hours by the end of internship?

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.

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* 2. Organizes work well.

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* 3. Has concern for quality of work.

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* 4. Displays ability to solve problems.

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* 5. Displays capacity for motivating others.

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* 6. Displays ability to lead and direct.

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* 7. Has ability to work independently.

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* 8. Possesses strong communication skills.

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* 9. Displays a marked capacity for work and production.

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* 10. Is critical of own performance and quality of work.

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* 11. Completes assignments on time.

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* 12. Shows concern for safety of others.

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* 13. Demonstrates ability to supervise personnel.

II. KNOWLEDGE

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* 14 Displays ability to integrate conceptual knowledge and activity skills.

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* 15. Displays knowledge and understanding of program principles and methods.

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* 16. Displays ability to apply knowledge in a practical way.

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* 17. Possesses and demonstrates expanding scope of interests.

III. PERSONALITY AND ATTITUDE

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* 18. Shows enthusiasm for work.

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* 19. Demonstrates initiative.

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* 20. Displays creativity and imagination.

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* 21. Displays average maturity for age.

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* 22. Displays flexibility.

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* 23. Is completely dependable.

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* 24. Has self-confidence.

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* 25. Gains respect of others.

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* 26. Is sensitive to the needs of others.

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* 27. Is tactful in relations with others.

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* 28. Accepts suggestions, directions, and critical evaluation well.

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* 29. Accepts assignments willingly.

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* 30. Upholds and follows agency policies.

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* 31. Uses authority constructively.

IV. PERFORMANCE APPRAISAL

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* A. Strengths: Describe the student’s outstanding abilities.

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* B. Suggestions for improvement: Describe the areas in which the student needs the greatest improvement.

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* Site Supervisor’s Evaluation for Employment

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* Evaluation was reviewed with student?

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* Evaluation was reviewed with instructor?

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* Site Supervisor’s Signature (please type name below)

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* Date

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 100% of survey complete.

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