CONFIDENTIAL

Northern Mindanao Medical Center

Cagayan de Oro City
PROFESSIONAL EDUCATION, TRAINING AND RESEARCH OFFICE (PETRO)
STUDENT’S INTERNSHIP/AFFILIATION EVALUATION FORM
Please help us continuously improve our Internship Program by taking time in assessing your internship experience here at NMMC
through this evaluation. Your responses will be kept confidential.
Name of Intern/Coordinator: ______________________________________________
School: __________________________________________ School Year: __________________________________
Training Program: _________________________________ Unit/Area(s) of Rotation: ________________________
Instructions:
Please answer the following questions as honestly as possible. Encircle the number that best reflects your experience.
1 = Poor, 2 = Unsatisfactory, 3 = Satisfactory, 4 = Very Satisfactory, 5 = Excellent

A. Work Environment
Clarity of organizational structure 1 2 3 4 5
Access to necessary materials and/or equipment 1 2 3 4 5
Collegiality/Friendliness of the employees 1 2 3 4 5
Employees’ attitude of respect for interns/affiliates 1 2 3 4 5
Access to one or more mentors (supervisor or employees) 1 2 3 4 5
Cooperation of hospital staff in providing professional growth
1 2 3 4 5
experiences through training
Physical working conditions 1 2 3 4 5
Application of classroom knowledge to the internship setting 1 2 3 4 5
B. NMMC Internship Coordinator/Supervisor
Sufficient orientation or description to one’s job or tasks 1 2 3 4 5
Provision of assistance in helping meet one’s personal and
1 2 3 4 5
professional goals and objectives
Provision of constructive, ongoing feedback 1 2 3 4 5
Willingness to listen to suggestions or recommendations 1 2 3 4 5
Availability and accessibility to questions/concerns 1 2 3 4 5
Function as a true mentor, teaching new knowledge and skills and
1 2 3 4 5
demonstrating appropriate professional behaviors and values
Adequate supervision throughout the duration of internship 1 2 3 4 5
Provision of sufficient quantity of quality work 1 2 3 4 5

C. Overall Evaluation of Internship Experience 1 2 3 4 5

D. Share any problems or concerns regarding your internship/affiliation experience we should know about
(if there’s any).
________________________________________________________________________________________
________________________________________________________________________________________
E. Suggest any ways the internship experience could be improved.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

___________________________________ ______________________
Signature over Printed Name of Intern/Affiliate Date

F-PET-076/Rev0/24JAN23