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Site Supervisor Evaluation Form

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SITE SUPERVISOR EVALUATION OF STUDENT FORM (BPC3126-7)

IUMW also relies on the site supervisor’s informed evaluation of the internship student in assessing the quality of
her/his performance and degree of learning. We ask you to take the time to provide a thorough and accurate
assessment of the performance of the intern named below. By sharing honestly and constructively of the
student’s performance, you will contribute significantly to her/his personal, intellectual, and professional
development.

Please fill out the entire form.

Name of Student: ………………………………………………

IUMW Matric No: ………………………….

PART I: STUDENT PERFORMANCE RATINGS

Using the scale provided, respond to the following statements about this intern’s performance and academic
capabilities. Please add additional comments as needed.

1= strongly disagree
2= somewhat disagree
3= neither agree nor disagree
4= somewhat agree
5= strongly agree
NA= Not applicable

Item The student Score


1 Achieved her/his internship learning objectives
2 Demonstrated necessary writing and speaking skills
3 Was able to apply classroom knowledge to the internship setting effectively
4 Demonstrated critical thinking and problem‐solving skills
5 Demonstrated initiative and the ability to learn
6 Responded well to supervision and constructive criticism
7 Showed the capacity to be a self‐sufficient, independent worker
8 Worked effectively with others on team projects
9 Exhibited a sense of responsibility and dependability
10 Exhibited a positive attitude toward work and co‐workers
11 Showed creativity and originality
12 Exhibited a professional attitude
13 Behaved ethically
14 Demonstrated sensitivity to diversity in the workplace
15 Adapted well to changing circumstances
16 Presented an appropriate professional appearance
17 Made progress throughout the internship
18 Completed a sufficient quantity of work
19 Produced quality work
20 Demonstrated awareness of her/his strengths/weaknesses
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PART II: EXTENDED CRITIQUE


Please respond to the following questions about the student’s performance and capabilities.
1. To what degree has the intern successfully achieved his/her learning goals?

2. Has the intern demonstrated professional growth and insight? Please be specific.

3. What are his/her greatest strengths?

4. What areas of performance or knowledge/skill deficiencies should the intern address to enhance his/her professional
potential?
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5. What constructive feedback would you offer to help the intern get more out of his/her next internship or to achieve success
at his/her first job upon graduation?

6. Which areas of the intern’s academic preparation appear to be strong or in need of improvement?

PART III: FINAL EVALUATION

How would you rate the intern’s overall performance? Circle/highlight the appropriate descriptor and number.
Benchmark the evaluation against the 20 criteria above as well as others you deem appropriate.

Poor: Recommend that academic credit not be awarded based on insufficient effort and performance as well as
lack of demonstrated learning

Below Average: Intern demonstrated effort, but performance was unsatisfactory and below expectations

Average: Intern satisfactorily met established learning standards and job performance expectations

Above Average: Intern somewhat exceeded average undergraduate learning standards and work performance
expectations based on criteria listed

Excellent: The intern demonstrated learning and development well exceeding the average and her/his
performance was exemplary on all standards
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PART IV: APPROVALS AND ACCOUNTABILITIES

1. Site Supervisor

The above is my evaluation of ………………….......................


I have reviewed my evaluation with the student.

Supervisor:
Signature:
Title:
Phone/Email:

2. Student Intern

I have read my supervisor’s evaluation and/or discussed the evaluation with my supervisor.

Signature:
Date:

3. Faculty Internship Coordinator

I have read the supervisor’s evaluation of the student.

Signature:
Date:

Note:
Intern/student has to return the form by attaching it with the final report to the IUMW Internship Coordinator.

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