RSU
Social and Behavioral Sciences
Intern Evaluation:
Supervisor Form
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Instructions:
This form is designed for supervisors to provide feedback about the performance of RSU interns. This form will become part of the interns record for this course and will be considered when assigning grades for the internship. Please answer each item using the scale provided.

Internship Site
Supervisor Name
Intern Name
Evaluation Date

Initial Comments


Answer Code for Evaluation Items and Questions
NA. - Not Applicable or not enough information to form a judgment
1 - Far Below Expectations - Needs much improvement to meet standards for interns
2 - Below Expectations - Needs some improvement to meet standards for interns
3 - Acceptable - Meets standards at average level for interns
4 - Above Expectations - Performs above average level for interns
5 - Far Above Expectations - Performs well beyond average levels for interns

I. Basic Work Requirements

Arrives on time consistently
Uses time effectively
Informs supervisor and makes arrangements for absences
Reliably completes requested or assigned tasks on time
Completes required total number of hours or days on site
Is responsive to norms about clothing, language, etc., on site

II. Ethical Awareness and Conduct

Knowledge of general ethical guidelines
Knowledge of ethical guidelines of internship placement
Demonstrates awareness and sensitivity to ethical issues
Personal behavior is consistent with ethical guidelines
Consults with others about ethical issues if necessary

III. Learning

Receptive to learning when new information is offered
Actively seeks new information from staff or supervisor
Ability to learn and understand new information
Understanding of concepts, theories, and information
Ability to apply new information in work or clinical setting

IV. Response to Supervision

Actively seeks supervision when necessary
Receptive to feedback and suggestions from supervisor
Understands information communicated in supervision
Successfully implements suggestions from supervision
Aware of areas that need improvement
Willingness to explore personal strengths weaknesses

V. Interactions with Clients

Appears comfortable interacting with clients
Initiates interactions with clients
Communicates effectively with clients
Builds rapport and respect with clients
Is sensitive and responsive to client's needs
Is sensitive to cultural differences
Is sensitive to issues of gender differences

VI. Interactions with Coworkers

Appears comfortable interacting with other staff members
Initiates interaction with staff
Communicates effectively with staff
Effectively conveys information and expresses own opinions
Effectively receives information and opinions from others

VII. Work Product

Reliably and accurately keeps records
Written or verbal reports are accurate and factually correct
Written or verbal reports are presented in professional manner
Reports are clinically or administratively useful
What would you identify as areas in which this intern should improve?
Would you recommend this intern for employment at his or her present level?

Thank you for your time in supervising this intern and in completing this evaluation.