Applied Health Science

Internships & Careers

MID-TERM EVALUATION
Field Experience in Public Health - To be completed by Site Supervisor
Student Name: *
Student Concentration: *
Internship Supervisor Name: *
Place of Internship: *
Dates of Reporting Period: *
Hours Worked During Reporting Period: *
Cumulative Hours Worked to Date: *

I. Status of Objectives, as related to the Memorandum of Understanding and Competencies.

Accomplished Activities: *

Activities Still in Progress: *

II. Perception of Intern's Personal Attributes and Professional Skills

Please use the number below to indicate the intern's personal attributes and professional skills.

  1= Poor 2= Below Average 3 =
Average
4 = Above Average 5 =
Excellent
N/A Comments
Competence in the Job

Decision Making Skills

Organizational Skills

Knowledge
Productivity
Initiative
Creativity
Accuracy and Thoroughness
Communication - Verbal
Communication - Written

Professionalism

Personal Appearance

Attitude
Punctuality
Dependability
Confidentiality
Adaptability

Interpersonal Relations

Community Relations

Staff Relations
Student Relations
Empathy
Cooperation
Friendliness
Listenting Skills

Personal Attributes

Enthusiasm

Persistence

Assertiveness

Maturity

Motivation

Self-Confidence

III. Evaluation of the performance of the intern

Strengths Detected *

Areas for Improvement *

IV. Suggested Changes in Objectives, Future Activities, if any

* indicates required field

When you are finished with your evaluation, click the Submit button below.