SUPERVISOR EVALUATION OF INTERN
Please identify your intern and circle a number between 1 and 5 to indicate your reaction to
his/her performance. Skip any items that do not seem to apply. Then mail this form to the
student’s advisor Dr. Chia-Ling Kuo at 405 White Hall, Kent State University, Kent, OH 44242.
1=strongly disagree
2=disagree
3=not sure
4=agree
5=strongly agree
Intern ____________________________________________:
1 2 3 4 5
1. completed the number of work hours contracted for
1 2 3 4 5
2. was reliable and responsible
1 2 3 4 5
3. conducted himself/herself in a professional manner
1 2 3 4 5
4. communicated effectively
1 2 3 4 5
5. was personable on the job
1 2 3 4 5
6. worked well with other employees
1 2 3 4 5
7. was able to successfully execute the types of tasks assigned
1 2 3 4 5
8. demonstrated skills with equipment
1 2 3 4 5
9. was astute about instructionally-related issues
1 2 3 4 5
10. showed initiative at appropriate times
1 2 3 4 5
11. worked effectively with teachers and other professionals.
1 2 3 4 5
12. worked effectively with students.
1 2 3 4 5
13. likely had a positive impact on student learning.
1 2 3 4 5
14. performed competently during the entire experience.
1 2 3 4 5
15. would be employable at this organization
In the space below, please clarify or expand upon these issues in a few sentences that sum up
your evaluation of this intern (or use the back, if necessary).
Name ____________________________________
Signature ____________________________________
Title ______________________________________