Intern Evaluation Form     Date: _______/_________/__________

Name:  _______________________________________

Organization: __________________________________

City:  ________________________________________  State: ______
   
Phone Number: (______) _______ - ______________ 

Email: ________________________________________
        
Student Name: _________________________________
        
Please rate the intern on the following areas:

Enter your response: 1=very low; 2=low; 3=average; 4=high; 5=very high

• self-direction and initiative in learning through the Internship: _____
 
• excellent communication skills with mentor and colleagues at the Internship site: _____
 
 
• the ability to learn from ongoing feedback: _____
 
 
• the ability to focus on goals: _____
  
• the ability to integrate and apply new learning: _____
 
 
• the overall success of this internship experience: _____
 
         
Additional Comments (optional):




Would you be willing to mentor an Intern again? 
 
 
Thank you very much for the time and support you have given to our student.


Delivery Options:

Mail to:
Tilman Sheets, Ph.D.
Department of Psychology and Behavioral Sciences 
College of Education 
Louisiana Tech University 
P.O. Box 10048 
Ruston, LA 71272-0001 

Fax to:
318-257-2379 (Fax) 

Email to (must be from a corporate/organization email address):
For response options (1-5) delete all but your selected response.
tilman@latech.edu