Evaluation of Student

Student and Supervisor

Student Name:	last first

Student Level:	if other:

Agency Name:

Type of Agency:	if other:

Field Placement Supervisor:	last first

Supervisor's Contact:	phone email

2. Requirements

   Did the student complete his/her required hours?
yes   no
If "No", how many hours remain at the time of completing this evaluation?

Evaluation Term: semester   year

Internship Dates(DD/MM/YYYY): start   end

Objectives

Consider the student’s Learning Objectives as described in the Internship Agreement/Field Placement Planning Form or as redefined over the course of the field placement.

How well did the student meet main objectives of the field placement?

above expectations completely somewhat needs work

Comments:

4. Performance

   Please rate the student's professional performance for each category below. Feel free to leave comments.
a. Organizational Skills
(sets priorities and reasonable deadlines, meets timelines for deliverables, completes tasks on time, fulfills commitment to others)
excellent   satisfactory   needs work   not at all   insufficient effort
Comments:

b. Communication Skills
(verbal and written, listening skills, asks for and gives feedback, contributions at meetings)
excellent   satisfactory   needs work   not at all   insufficient effort
Comments:

c. Interpersonal Skills
(relationship with coworkers, relationshp with supervisor, team player)
excellent   satisfactory   needs work   not at all   insufficient effort
Comments:

d. Attitude and Initiative
(self-reliant, resourceful, flexible, dependable, curious)
excellent   satisfactory   needs work   not at all   insufficient effort
Comments:

e. Critical and Strategic Thinking Skills
(assess information to make informed decisions; sees the big picture and understands how actions fit into a plan; problem solves)
excellent   satisfactory   needs work   not at all   insufficient effort
Comments:

f. Technical Skills
(application of skills expected of this position)
excellent   satisfactory   needs work   not at all   insufficient effort
Comments:

g. Additional Comments on Student's Performance:

5. School/University Support

   a. Had you served as a Field Placement Supervisor for the SPH in the past?
yes   no
b. Would you be willing to serve as a Field Placement Supervisor next semester?
yes   no
c. Did you receive support from the SPH as needed?
(communication with Field Placement Coordinator, Faculty Advisor, answers to questions, etc)

d. What is your overall rating of the field placement experience?
outstanding   good   average   fair   poor
Comments:

Do you have any other recommendations for improving
the SPH Field Placement Program?