ClaremontGraduateUniversity
MasterofPublicHealthProgram
CGH306:SupervisedFieldTraininginPublicHealth
FIELDSUPERVISOR’SEVALUATIONOFSTUDENT
Thisevaluationisdesignedprimarilytoprovidefeedbackonjobperformanceandrelatedissuestoassistthestudentinhis/her
academic,personal,andprofessionaldevelopment.Pleasereviewanddiscussyourevaluationwiththestudent.Thankyoufor
takingthetimetoserveasasitesupervisor.Yourparticipationisvaluedbythestudentandtheprogram.
StudentName:
FieldSupervisorNameandTitle:
NameofAgencyandDivisionorDepartment:
DatesofPlacement:
Recordyourappraisalofthestudent’sperformancebywritingtheappropriatenumberintheblankaftereachitem.Forany
itemswitharatingof“1”of“2,”pleaseprovideanexplanationinthespaceprovided.Commentsonanyotheritemswouldalso
helpthestudentareencouraged.Use“N/A”iftherehasbeennoopportunitytoobservetheskill,orifitisnotrelevanttothe
worksetting.
I.GENERALJOBPERFORMANCE
Beyondexpectation
5
4
1.INTERPERSONALSKILLS
a.Abilitytocommunicatewithstaff
b.Abilitytocommunicatewithclientele
c.Abilitytoworkwithandforothers
2.SUPERVISION
a.Abilitytoseekandusehelp
b.Opennesstoconstructivecriticism
c.Abilitytoworkindependently
3.PERSONALQUALITIES
a.Decisionmaking
b.Trustandconfidentiality
c.Initiative
Satisfactory
Belowexpectation
3
2
1
Rating
Comments
FieldSupervisorEvaluation
Beyondexpectation
5
4
d.Creativity
e.Dependability
f.Punctuality
g.Professionalappearance
h.Abilityandwillingnesstolearn
i.Adaptability
j.Adherencetoagencyrules/norms
4.SKILLS
a.Communication(verbal/written)
b.Analyzingproblems
c.Problemsolving
d.Organization
e.Follow-through
f.Meetingdeadlines
5.OVERALLSTUDENTRATING
a.Takingallitemsintoconsideration,howwould
youratethisstudent’sperformanceatyouragency?
Page2
Satisfactory
Belowexpectation
3
2
1
Rating
Comments
II.ACHIEVEMENTOFPROJECTOBJECTIVES
Inreviewingtheprojectobjectivesoutlinedintheinternshipcontract(seescopeofwork),assesstheextentto
whichyoubelievethestudentachievedtheseobjectives.Discussbywhatmeansyoucandeterminewhethereach
projectobjectivewasmet.Pleaseuseaseparatesheetofpaperifnecessary.
ProjectObjectives
Met(Y/N)
MeasuresofSuccess
1.
2.
3.
FieldSupervisorEvaluation
Page3
4.
5.
III.ATTAINMENTOFMPHSTUDENTCOMPETENCIES
InreviewingtheMPHstudentcompetenciesoutlinedintheinternshiplearningcontract(seeMPHcompetency
inventory),assesstheextenttowhichyoubelievethestudentmasteredthesecompetenciesduringtheir
supervisedfieldtrainingexperience.Discussbywhatmeansyoucandeterminethesewereachieved(i.e.,
measuresofsuccess).
MPHStudentCompetency
Levelof
MeasuresofSuccess
Mastery**
(C/SC/NC)
CorePublicHealthCompetencies(3)
a.
b.
c.
ConcentrationSpecificCompetencies(2)
a.
b.
*Restatecompetenciesselectedininventory
**Choicesinclude:C=Competent;SC=SomewhatCompetent;NC=NotCompetent
FieldSupervisorEvaluation
Page4
IV.PROFESSIONALGROWTHOPPORTUNITIES
1.Identifytheareasofprofessionalgrowthyouhavenoticedinthestudentoverthecourseoftheinternship?
2.What“professionaldevelopmentplan”wouldyourecommendtothestudent(e.g.,additionalcourses,skillsor
experiencethatwouldstrengthenhis/hercareerpotentialinpublichealth)?
3.Inyouropinion,howwelldopreparedwasthestudenttoundertakethetasksaskedofhim/herduringthe
courseoftheinternship?Pleasemakeasectionbelowandelaborateifappropriate.
a.Veryprepared
b.Somewhatprepared
c.Notverywellprepared
SUPERVISORSIGNATUREDATE
Pleasesubmitformto:
DarleenPeterson,PhD,MPH,MCHES
AssociateProfessor&Director
MPHProgram
FacultyInternshipSupervisor
ClaremontGraduateUniversity
SchoolofCommunity&GlobalHealth
675WestFoothillBlvd.Suite310
Claremont,CA91711
Phone:(909)607-6729
Fax:(818)952-2915
e-mail:darleen.peterson@cgu.edu