PHILIPPINE SCIENCE HIGH SCHOOL SYSTEM

CAMPUS: ___________________________

Science Immersion Program

STUDENT'S PERFORMANCE EVALUATION

Student-intern: _________________________________________________________________
Agency: _________________________________________________________________
Address of Agency: _________________________________________________________________
Agency Supervisor: _________________________________________________________________

To the Supervisor: Please indicate your rating of the intern in each criterion. Your feedback is crucial to our assessment of
the immersion program. Return this form to tahe student-intern upon completion of the SIP in a sealed signed envelope
provided.

CRITERION 3 2 1 Your rating

Attendance and Reports on time with no more Has incurred no more than three Has incurred more than three
Punctuality than one unexcused absence tardiness and/or unexcused unexcused absences
and/or one tardiness absences

Work Ethics Performs all of the assigned work
without any need of reminders;
Work reflects best effort, and is
ready on time or sometimes
ahead of time; Demonstrates
integrity in speech and
action at all times.
Attitude and Personality Displays a positive attitude
towards the assigned tasks.
Never publicly critical of others;
Wears appropriate attire.
Performs most of the assigned Performs very little of the
work though sometimes needs assigned work; Some of the
reminding; Work reflects some assigned work never gets
effort, and is sometimes completed and reflects very little
accomplished late. effort; Often needs reminding;
Failed to demonstrate integrity in
speech or
action several times.
Displays a positive attitude Displays negative attitude
towards the assigned tasks most towards the tasks; Does not get
of the time but encounters along well with most people;
difficulty in getting along with Often publicly critical of others;
some people; Sometimes publicly Does not dress appropriately
critical of others; Wears most of the time.
inappropriate attire in
one or two instances.

Respect for authority,
colleagues, and agency
rules and regulations
TOTAL
Courteous and respectful to
superiors and colleagues at all
times; Listens to and supports the
efforts of others; Obeys rules and
regulations at all times.
Courteous and respectful to Often rude or impolite; Rarely
superiors and colleagues most of listens to and supports the efforts
the time; Often listens to and of others; Often disregards rules
supports the efforts of others; and regulations.
Obeys rules and regulations most
of
the time.

If you have any comments or observations about this intern, please write them below.
(Continue on separate sheet if necessary)

Signature of Agency Supervisor _ Date _

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