Practicum student evaluation form

Name of Practicum/Internship Student:______________________________________

Date:____________________

Practicum Setting:________________________________

A. Please rate the student in each area using the following scale:

5-excellent, 4-good, 3-adequate, 2-fair, 1-poor, or N/A if you have had no opportunity to observe the student in this area.

1. Acceptance of responsibility (follows direction, keeps on job without close supervision).

2. Displays initiative in his or her work (starts work without being told).

3. Relationship with other employees, students (tact, courtesy, cooperation).

4. Relationship with the supervisor.

5. Displays accuracy in his or her work (thorough and efficient).

6. Promptness in reporting to work.

7. Regularity in reporting to work.

8. Personal cleanliness, grooming, and dress appropriate to job.

9. Conduct, (honesty, integrity, and respectfulness); uses good judgment.

10. Personal traits (cheerfulness, sense of humor, ability to take criticism, self-confidence).

11. Speed (work performance, promptness in completing assignments).

12. Skills used on the job (how well they have been mastered).

13. Ability to handle workload (effectiveness).

B. Please write in your comments following each question.

1. What strengths did this student bring or develop during practicum under your supervision?___________________________________

2. As you see it, what are some areas that continue to be challenges for this student?__________________________________________

3. In your opinion, are there some areas in which the student needs more experience?___________________________________________

4.. What is your overall impression of this student?______________________________________________________________________________

Thanks for taking the time to complete this form. You may give it directly to the student who will turn it in to me or mail it to:

Paula Wolfteich, Ph.D.

901 N. Patterson St.

Valdosta, GA

31605

Please share this feedback with the student and sign below.

_________________________ __________________________

Signed: On-Site Supervisor Signed: Intern

Date:_____________________ Date:______________________