Submit by Email
APPENDIX L
UNIVERSITY SUPERVISOR EVALUATION
Instructions:
This form is to be completed by the student and submitted to the address identified at the
end of the form. This form will be kept confidential from the university supervisor until
the end of the academic year and until at least 5 such forms are accumulated.
Name:_______________________________
Date:___________________
Site of Internship:_________________________________________________________
Please answer each of the following questions. If you need additional space, attach
separate sheets. This evaluation form will not be shared with your university supervisor
until the end of the academic year. No evaluation will be shared with a university
supervisor until that supervisor has at least five returned evaluations from students. At no
time will the supervisor see the original evaluation from the student. All information will
appear in aggregate format based on at least five evaluations. All final grades will be
posted before any internship aggregate evaluation information will be shared with the
university supervisor. All evaluation feedback is completely confidential and the
university supervisor will not be able to identify the source of any comment.
1.
Did your university supervisor distribute and go over the internship manual?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
2.
Were you fully aware of all logs, reports, journals or other required assignments
that were part of the successful completion of the internship?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
_______________________________________________________________
Print Form
3.
Were you fully aware of all due dates for the required assignments that were part
of the successful completion of the internship?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
4.
Did your university supervisor complete evaluations as specified in the internship
manual?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
_______________________________________________________________
5.
Did your university supervisor visit your site at least once during your internship?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
_______________________________________________________________
6.
Did the university supervisor appropriately notify you for any missing
assignments or for not fulfilling your assigned duties in your internship?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
7.
Did the university supervisor provide you with sufficient opportunity to interact
during supervisory conference either by email, on site or by phone?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
8.
Did the university supervisor communicate with you at a level consistent with
your professional development?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
9.
Was your university supervisor readily available to you in order to answer your
questions or discuss any concerns you might have about your internship?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
10.
Did the university supervisor convey specific areas of strengths or weaknesses to
you?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
11.
Did the university supervisor show respect for you as an individual during any
conference or evaluation?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
12.
Did the university supervisor appropriately encourage you to become an
independent/autonomous professional?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
13.
Did the university supervisor maintain confidentiality about your performance
during the internship?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
14.
Did the university supervisor encourage you to initiate strategies for future
professional experiences?
Yes
No
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
15.
Did the university supervisor encourage you to reflect on your internship
experience?
No
Yes
If not, why not?_________________________________________________
______________________________________________________________
______________________________________________________________
PLEASE RETURN THE COMPLETED FORM TO THE DEPARTMENT OF
HEALTH AND PHYSICAL EDUCATION, PEABODY 103, WINTHROP
UNIVERSITY, ROCK HILL, SC 29733.