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Please respond to the following questions regarding your internship experience.
The purpose of this form is to provide opportunity for an honest appraisal of the internship site and Supervisor and its contribution to your school’s experiential education program.

Semester/Year
Location
Supervisor

1. Please rate the following aspects of your internship placement on the basis of this scale:
(0) No Observation
(1) Poor
(2) Fair
(3) Good
(4) Excellent

Work experience relates to my area of study
Adequacy of employer supervision
Helpfulness of supervisor
Acceptance by fellow workers
Opportunity to use my training
Opportunity to develop my human relations skills

Provided levels of responsibility consistent with my ability and growth
Opportunity to develop my communication skills
Opportunity to develop my creativity

Cooperativeness of fellow workers
Opportunity to problem solve
Opportunity to develop critical thinking skills

Provided orientation to the organization
Attempt to offer feedback on my progress and abilities
Effort to make it a learning experience for me

Comments

2. Would you work for this supervisor again?	Yes No Uncertain

3. Would you work for this organization again?	Yes No Uncertain

4. Would you recommend this organization to other students?	Yes No Uncertain

Why or why not?

Your Name

Date

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