Intern Feedback for Agency Site

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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

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

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