Intern Evaluation (Supervisor)
Intern Name: __________________
Please rate the intern’s demonstration of:
Very Poor
1.
Initiative and enthusiasm
2.
Dependability, reliability, and
conscientiousness
3.
Ability to work with individuals
of diverse backgrounds
4.
Response to feedback and
constructive criticism
5.
Management skills
6.
Knowledge of the aging process
7.
Understanding of aging
individuals and their
relationships to other
institutions
8.
Understanding of resources and
challenges of aging individuals
and their families
9.
Understanding of the principles
associated with evidence based
and best practices
10. Understanding of professional
standards of behavior
11. Ability to assess situations for
potential ethical dilemmas
12. Ability to solicit and evaluate
information from families and
individuals to assess their
concerns and needs
13. Professional oral and written
communication skills
14. Overall assessment of
performance
Poor
Neutral
Good
Very Good
15. What has the student done well during the internship experience?
16. What competencies/skills do you feel need further development?
17. Do you have any concerns about the performance of this student in this placement?
20. How well prepared was this student with the knowledge and skills for an entry level position with your agency?
(circle one)
Very well prepared
Prepared Not Sure Unprepared
Very Unprepared
21. Compared to new employees you have worked with in the past, how would you compare the performance of
this student?
Well above average
Above average
Average
Below Average
Well below average
Signature: _______________________________________
Printed Name and Title: ____________________________________
Please send or fax to:
Elaine Eshbaugh, PhD
241 Latham Hall
Cedar Falls, Iowa 50614-0332
Fax 319-273-7096
Phone 319-273-6083
Elaine.eshbaugh@uni.edu
Intern Evaluation (Self)
Intern Name: __________________
Please rate your demonstration of:
Very Poor
1.
Initiative and enthusiasm
2.
Dependability, reliability, and
conscientiousness
3.
Ability to work with individuals of
diverse backgrounds
4.
Response to feedback and
constructive criticism
5.
Management skills
6.
Knowledge of the aging process
7.
Understanding of aging individuals
and their relationships to other
institutions
8.
Understanding of resources and
challenges of aging individuals and
their families
9.
Understanding of the principles
associated with evidence based and
best practices
10. Understanding of professional
standards of behavior
11. Ability to assess situations for
potential ethical dilemmas
12. Ability to solicit and evaluate
information from families and
individuals to assess their concerns
and needs
13. Professional oral and written
communication skills
14. Overall assessment of performance
Poor
Neutral
Good
Very Good
15. What have you done well during the internship experience?
16. What competencies/skills do you feel need further development?
17. Do you have any concerns about your performance in this placement?
Signature: _______________________________________
Printed Name: ____________________________________
Please send or fax to:
Elaine Eshbaugh, PhD
241 Latham Hall
Cedar Falls, Iowa 50614-0332
Fax 319-273-7096
Phone 319-273-6083
Elaine.eshbaugh@uni.edu