Intern Evaluation Form (for Site and University Supervisors)

St. Bonaventure University

__x__200 Hour Practicum

____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 __Dr. Lauren Ormsby_________________

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 grew during his experiences in the practicum and internship. Adam looked to accomplish all
600 hours in one summer which is almost too much to try and do and at times contributed to his not
making deadlines but Adam always took responsibility and worked with his site supervisors to rectify
the situation.

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) 4LEADERSHIP 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