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1. Cal Poly Intern Name: (Required.)

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2. (Your) Supervisor Name: (Required.)

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3. Supervisor Title: (Required.)

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4. Supervisor Phone and Email: (Required.)

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5. Company Name: (Required.)

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6. Internship start date?

Date

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7. Internship completion date:

Date

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8. What were the total hours worked by this intern? (Required.)

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9. What do you feel were the primary strengths of this intern?

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10. What do you feel were the primary weaknesses of this intern?

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11. Would your company hire this intern for full-time employment, now or in the future?

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12. Generally speaking, are you satisfied that your company benefited from participation in the Internship program, insofar as it involved this student?

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13. What suggestions do you have, if any, for improving the internship program?

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