Appendix M
Department of Engineering Technology
601 University Drive, San Marcos, TX 78666
512-245-2137 (office)
512-245-3052 (fax)
MIDTERM EVALUATION OF INTERNSHIP – Industrial Supervisor
DUE: End of the 5th week of the internship. Submit by email, fax, or mail to the student’s Faculty
Supervisor.
Student Name
Date
Supervisor’s
Name
& Title
Host
Organization
Supervisor’s
Phone
Supervisor’s
Email
PRELIMINARY EVALUATION
Days
Worked
Hours Worked
1. Is the intern reporting to work on time?
Yes
No
2. Is the intern appropriately dressed for work?
Yes
No
LEARNING OUTCOMES EVALUATION
MEETS EXPECTATIONS
1
Does not
2
Rarely
3
Neutral
4
5
Sometimes Consistently
6
N/A
Critical thinking and problem solving
Comments
Ability to learn
Comments
Taking initiative and the ability to engage
in self-directed professional development
(lifelong learning)
Comments
Interpersonal skills (people skills)
Comments
Team working skills
Comments
Able to work well in a diverse
environment (cultural, gender, age,
company position, etc.)
4/17/2015
Comments
Oral communication
Comments
Written communication
Comments
Professional skills
Comments
Good work habits
Comments
Sound ethics and integrity
Comments
Timeliness
Comments
Time management
Comments
Knowledge of contemporary issues
Comments
Understands the societal impacts of
technical solutions
Comments
What improvements could be
made by the intern to
enhance their performance?
Please provide any additional
comments on the internship
experiences of the student.
Response is optional:
$0-10/hr
$11-15/hr
$16-20/hr
Other
What is the range of pay offered to the intern?
Comments
Please discuss the above evaluation with the intern. This is a key part of their learning
process.
Industry Supervisor’s
Signature
Date
4/17/2015
4/17/2015