I

Intern Evaluation Form

Two (2) evaluations, a midterm and final evaluation will be completed by the agency supervisor
using the form below. The midterm evaluation should be used to determine places for improvement
and to evaluate the student's program to date. The final evaluation should be used to determine the
overall performance of the intern.

Name of Student:At;.e.:,, k.e.o,s \ e✓ Date:

Name of Supervisor: 0 D-c-- A..,_,Jc)

1. Goals and Objectives: List each professional goal and objective jointly established and progress
towards completing it.

Goals and Objectives Status Comments

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2 · Attitudes and Skill Development:
Beyond Expectations Met Expectations Below Expectati ons
a. Understanding of agency's goals and
operations X
b. Knowledge of the field
1--
C. Planning and organizing work and
schedule ~
d. Attitude toward duties
~
e. Dependability y.
f. Initiative
A..
g. Seeks responsibility
"/..,
h. Accepts direction )(
i. Interaction with staff )(
j. Interaction with public -~

k. Oral communication
1'
...
I. Writing ability
~
m. Leadership performance
~
n. Quantity of work
~
0. Quality of work
~
p. Grasps concepts and implements them
K
l

3. Motivation:
For each of the following, when appropriate, briefly comment on the intern' s abilities, strengths, and
weaknesses, and where/how they might focus future efforts.

a. Knowledge- has information and skills appropriate to the field, balance between theory and
applications; exerts efforts for new developments and trend_s:__ __ _Q .., , _ ~~
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b. Leadership- enthusiasm, inspiring, evaluating ability, planning and organ1zat1onal skills. \o n..o
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c. Social- pleasanxfriendly, tactful, impressions by others, conversationalist.

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d. Performance- time management and productivity, dependability, initiat ive, attitude, judgment.
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4. Overall Evaluation of Performance

~ceeded expectations D Met expectations D Below expectations

6 Average D Poor

5. Professional Evaluation of Student:

Given my observations and interaction with the student, I...
~ck one)
}6L Highly Recommend
D Recommend

D Recommend with Reservation

D Would Not Recommend ...this individual for a position in the field.

Why?:

6. Ranking:
Compared to the _(number) interns our agency has had in the last five years, I would rank this
intern in the:
~ o p 10th percentile D
Upper 50th percentile D
Lower 50th percentile D Bottom quartile

7. Signature:
The signing of this form indicates the intern has reviewed and discussed the evaluation and does not
indicate that the intern necessarily agrees with the judgments in the evaluation.

Date .:::K/EvJ$.

Submit to: Julie Knapp, Ph.D. Internship Coordinator

Indiana University, School of Public Health
Department of Recreation, Park and Tourism Studies
SPH Room 133, 1025 E. Seventh St., Bloomington, IN 47405