Youth Internship Feedback Form

Instructions: Thank you for participating in our internship stipend program! Please fill out the following questions. We appreciate your feedback!

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* 1. Youth Applicant Information

Youth Name

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* 2. How would you rate your internship experience?

Excellent

Satisfactory

Poor

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* 3. Please select how you feel about each skill.

	Strongly Agree	Agree	Slightly Agree	Disagree
I learned about tribal health professions and career paths.	I learned about tribal health professions and career paths. Strongly Agree	I learned about tribal health professions and career paths. Agree	I learned about tribal health professions and career paths. Slightly Agree	I learned about tribal health professions and career paths. Disagree
I learned about Research & Evaluation Methods, Community-Based Participatory Research Strategies, or Data Literacy.	I learned about Research & Evaluation Methods, Community-Based Participatory Research Strategies, or Data Literacy. Strongly Agree	I learned about Research & Evaluation Methods, Community-Based Participatory Research Strategies, or Data Literacy. Agree	I learned about Research & Evaluation Methods, Community-Based Participatory Research Strategies, or Data Literacy. Slightly Agree	I learned about Research & Evaluation Methods, Community-Based Participatory Research Strategies, or Data Literacy. Disagree
I have a relationship with a health professional that I can turn to and ask questions.	I have a relationship with a health professional that I can turn to and ask questions. Strongly Agree	I have a relationship with a health professional that I can turn to and ask questions. Agree	I have a relationship with a health professional that I can turn to and ask questions. Slightly Agree	I have a relationship with a health professional that I can turn to and ask questions. Disagree
I have participated in a health-related job shadow, internship or job experience.	I have participated in a health-related job shadow, internship or job experience. Strongly Agree	I have participated in a health-related job shadow, internship or job experience. Agree	I have participated in a health-related job shadow, internship or job experience. Slightly Agree	I have participated in a health-related job shadow, internship or job experience. Disagree

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* 4. How likely are you to pursue a career in health or wellness?

Very likely

Somewhat likely

Still Uncertain

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* 5. What did you learn from the internship?

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* 6. Is there anything else you’d like to share with us about your experience?

The Northwest Portland Area Indian Health Board, We Are Healers, and We R Native and are committed to supporting American Indian & Alaska Native youth (14-24 years old) interested in pursuing healthcare professions.

Acknowledgements: This work is supported by the Administration for Native Americans, grant number: 90NC0022 (We R Native Youth Development Project).