Link back to main EIU page
A to Z IndexApply Online with EIU
Alumni and Friends Parents Faculty and Staff EIU Students
Eastern Illinois University - Charleston, IL

EIU Psychology Department

EIU Psych RSS

On-site Supervisor Evaluation of Intern

Thank you for your assistance. We appreciate your feedback!

Name of Intern:

Name of On-site Supervisor:

Agency:

Dates of internship: month-day-year to month-day-year

1. Please describe the student’s undergraduate internship experience with your site, including his or her responsibilities and his/her performance.

2. What are the psychological activities engaged in by the intern at your site? (For instance: observation of clinical work or interviews, reviewing reports/case files, group activities, testing, intake, report writing, group counseling)

3. How often does the intern follow agency policies and procedures (e.g., professional conduct, appropriate dress, being on time, and following line of authority)?

4. How often is the intern able to work effectively with supervisors and other agency staff?

5. How often does the student appropriately respond to supervision, feedback and self-evaluation?

  Poor Fair Good Excellent Outstanding Not Applicable
6. How would you judge the intern’s abilities in the following areas:            
a) understand the problems of others
b) accept options and actions different from his/her own
c) adjust to change or a new situation
7. Please evaluation the intern on the following areas:
a) motivation, commitment
b) dependability
c) emotional maturity
d) initiative
e) judgment
f) attitude towards job
g) attitude towards patients or clients
h) sensitive, ethical behavior
8. How well does the intern work with the following:
a) Individuals
b) groups
c) Children
d) Adolescents
e) Senior Citizens
f) Other Clients (Specify):
9. How well does the student work with diverse populations, including low income clients and people of different ethnicities?

10. Please state any areas in which the intern needs work.

  Eastern Illinois University :: 600 Lincoln Avenue :: Charleston, IL 61920-3099 :: 217-581-5000 :: Contact Us :: Maps & Directions :: Text Only :: Privacy Statement :: Confidentiality Statement :: Mission Statement :: Federal and State Mandated Information