Intern Evaluation Form (for Site and University Supervisors)

St. Bonaventure University

____200 Hour Practicum

___x_400 Hour Internship
(check one)

Site Supervisors Evaluation Form

University Supervisors Evaluation Form
The criteria evaluated on this form are based upon and reflective of the Knowledge, Skills and
Dispositions mentioned on pages 4-5 of the Internship Guide. They are coded by their appropriate K, S,
and D numbers below.

Please check the appropriate box indicating which evaluation form you are filing. Make copies of this
evaluation form for each supervisors as well as the interns evaluation.

Interns Name Adam Erickson

Site Supervisors Name __Mr. Joshua Liddel_________________

University Supervisors Name Dr. Margaret Jones-Carey _____

Site _

I. OVERALL EVALUATION

Please indicate a general evaluation of the accomplishment of the stated competencies of the internship.

(Check One)

Outstanding Very Good Good Satisfactory Unsatisfactory

COMMENTS: (Use additional sheet if necessary)

Adam completed his internship. He developed positive relationships with his site supervisor and with
the staff and has had to learn to balance interest with attention to the work at hand.

II. PROFESSIONAL CRITERIA

For each of the criteria listed below, please provide both a numerical self-evaluation and any pertinent
comments about the internship experience.
For numerical evaluation, use the following scale:

5 - Outstanding 4 - Very Good 3 - Good 2 - Satisfactory 1 - Unsatisfactory

A) 4 LEADERSHIP ABILITY (K1, K2, K3, S3, D1, D4, D6 - e.g. ability to inspire other, set
and reach goals, create positive action, solve problems, etc.)

COMMENTS:

B) 5 PROFESSIONAL MOTIVATION (D3, D4 - e. g. clear goals, high level of

professional interest and motivation, etc.)

COMMENTS:

C) 4 PERSONAL CHARACTERISTICS (D2, D5, D6 - e.g. sense of humor, poise, self-

control, ability to handle crises and stress, honest, etc.)

COMMENTS:
Adam has a tendency to over commit and then misses deadlines. It seems that through this
experience he has learned that he must prioritize and set reasonable timelines for completing work.

D) 5 INTERPERSONAL RELATIONS (D2, D3, D4, D4, D6 - e.g. ability to relate to

others, work with groups, acceptance of criticism, respect for others, etc.)

COMMENTS:
E) 5 PROFESSIONAL COMPETENCE (K1, K2, K3, S1, S2, S3, D1, D2, D3, D4, D6 - e.g.
successful completion of tasks and assignments, demonstrates understanding of nature of
administration, includes dependability, demonstrates initiative, assumes responsibility, able
to work independently, punctual, etc.)

COMMENTS:

F) 4 WRITTEN COMMUNICATION (S1, S2 - e.g. fluency, accuracy, command of the

language, timeliness, grammar, etc.)

COMMENTS:

G) 5 ORAL COMMUNICATION (S1, S2 - e.g. fluency, poise ability to articulate,

enunciation, grammar, etc.)

COMMENTS:

H) ADDITIONAL COMMENTS (Comments/observations not covered in prior question areas)

 ______________8/28/2017___________________

Signature Date