DEPARTMENT OF INFORMATION TECHNOLOGY

SUPERVISORS FEEDBACK FORM

INTRODUCTION The intention of this assessment instrument is to provide the industry exposure candidate with feedback concerning both general and specific professional skills and competencies. We ask that you be objective and candid in your assessment and that you discuss it with the candidate Assessment ratings range from 1 (low) to 5 (high) as follows: 1 - Unsatisfactory 3 - Average 5 - Exceptional NA (Never demonstrates this ability/does not meet expectations) (Sometimes demonstrates this ability/meets expectations) (Always demonstrates this ability/consistently exceeds expectations) (Not applicable or not observed in this industry exposure experience) . Please do not feel compelled to write comments in each section. A. Ability to learn 1. 2. 3. 4. 5. Observes and/or pays attention to others Asks pertinent and purposeful questions Seeks out and utilizes appropriate resources Accepts responsibility for mistakes and learns from experiences Open to new experiences 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

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B. Reading/Writing Skills 1. 2. Reads/comprehends/follows written materials Communicates ideas and concepts clearly in writing 1 1 2 2 3 3 4 4 5 5 N/A N/A

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C. Oral Communication/Listening Skills 1. 2. 3. 4. Listens to others in an active and attentive manner Comprehends and follows verbal instructions Effectively participates in meetings or group settings Demonstrates effective verbal communication skills 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 N/A N/A N/A N/A

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D. Creative Thinking & Problem Solving Skills 1. 2. 3. 4. 5. Seeks to comprehend and understand issues in their larger context Breaks down complex tasks/problems into manageable pieces Brainstorms/develops options and ideas Respects input and ideas from other sources and people Demonstrates an analytical capacity 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

Comments:

E. Professional & Career Development Skills 1. 2. 3. 4. 5. Seeks to understand personal strengths and weaknesses Exhibits self-motivated approach to work Demonstrates ability to set appropriate priorities/goals Exhibits professional behavior and attitude Shows interest in determining career direction 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

Comments:

F. Interpersonal & Teamwork Skills 1. 2. 3. 4. 5. Relates to co-workers effectively Manages and resolves conflict in an effective manner Supports and contributes to a team atmosphere Controls emotions in a manner appropriate for work Demonstrates assertive but appropriate behaviour 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

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G. Organizational Effectiveness Skills 1. 2. 3. 4. 5. Seeks to understand and support the organizations mission/goals Works within the norms and expectations of the organization Works within appropriate authority and decision-making channels Demonstrates confidentiality Interacts effectively and appropriately with supervisor 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

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H. Basic Work Habits 1. 2. 3. 4. Reports to work as scheduled Is prompt in showing up to work and meetings Exhibits a positive and constructive attitude Dress and appearance are appropriate for this organization 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 N/A N/A N/A N/A

Comments:

I. 1. 2. 3. 4. 5.

Character Attributes 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

Brings a sense of values and integrity to the job Seeks to serve others even at the risk of personal inconvenience Respects the privacy of others Behaves in an ethical manner Respects the diversity (religious/cultural/ethnic) of co-workers

Comments:

J. Open Category: Industry-Specific Skills Are there any skills or competencies that you feel are important to the profession or career-field (represented by your organization) that have not been previously listed in this evaluation? If so, please list these skills below and assess the student accordingly. 1. 2. 3. 4. 5. Comments: 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 N/A N/A N/A N/A N/A

K. Overall Performance 1. 2. 3. Would you supervise this student again? Would your organization host this student again? Would you recommend this student to other organizations? Why or why not? Overall Performance of this student Unsatisfactory Poor Average Good Outstanding Yes Yes Yes No No No Uncertain Uncertain Uncertain

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SIGN OFF Evaluators Signature: ___________________________________________Date: ___________________ Title/Position: ___________________________________________Telephone:(____)_________________ E -Mai Address:________________________________________________________________________

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