College of Education
Department of Educational Psychology
Supervised Internship Experiences
Intern Name (Last, First, MI): NAU ID:
Program: M.A. Counseling
Agency Name:
Campus:
Semester/Yr:
DIRECTIONS: The intern is to complete this evaluation form at the end of the internship. The original completed form is given to the Faculty Supervisor and a copy is given to the Agency Supervisor.
The site provided me with:
Strongly Disagree
1.
Experience relevant to career my career goals. 1 2
2.
Exposure to program policies & procedures. 1 2
3.
Exposure to professional roles & functions within the program.
4.
Exposure to inter-agency partnerships.
5.
Exposure to an atmosphere that promotes cooperation & teamwork.
6.
Overall evaluation of site.
Strengths of the agency site:
1
1
1
1
2
2
2
2
Areas that could be improved at the agency site:
Agree Strongly Agree
3
3
3
3
3
3
4 5
4 5
4 5
4 5
4 5
4 5
Intern Signature: _____________________________________ Date:______________
Agency Supervisor Signature: ___________________________ Date:______________
Faculty Supervisor Signature: ___________________________ Date:______________
Revised: HGD, June 22, 2015