Intern Feedback for Agency Site

advertisement
College of Education
Department of Educational Psychology
Supervised Internship Experiences
M.A. Counseling – Intern Feedback for Agency Site
(Must be typed)
Intern Name (Last, First, MI):
NAU ID:
Program: M.A. Counseling
Campus:
Agency Name:
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
Agree
Strongly Agree
1. Experience relevant to career my career
goals.
1
2
3
4
5
2. Exposure to program policies &
procedures.
1
2
3
4
5
3. Exposure to professional roles &
functions within the program.
1
2
3
4
5
4. Exposure to inter-agency partnerships.
1
2
3
4
5
5. Exposure to an atmosphere that
promotes cooperation & teamwork.
1
2
3
4
5
6.
1
2
3
4
5
Overall evaluation of site.
Strengths of the agency site:
Areas that could be improved at the agency site:
Intern Signature: _____________________________________
Date:______________
Agency Supervisor Signature: ___________________________
Date:______________
Faculty Supervisor Signature: ___________________________
Date:______________
Revised: HGD, June 22, 2015
Download