Section 1 of 1
Intern Mid-Point Internship Feedback Form
Please complete this form to provide mid-point self-reflection on your internship experience. The feedback will be used to validate/enhance your performance and to improve our district programs.
Student Name:
Student Name:
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Supervisors Name:
Supervisors Name:
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Internship Title/Role:
Internship Title/Role:
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Time
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Takes initiative in completing tasks or suggesting new projects
Takes initiative in completing tasks or suggesting new projects
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
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Takes responsibility for their own work
Takes responsibility for their own work
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
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Shows willingness to learn new concepts, ideas, and methods
Shows willingness to learn new concepts, ideas, and methods
Question Type
Short answer
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
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Answer key
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Demonstrates efficient use of time
Demonstrates efficient use of time
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
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…
Answer key
(0 points)
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Takes action on feedback provided by supervisors
Takes action on feedback provided by supervisors
Question Type
Short answer
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
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Answer key
(0 points)
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Works effectively with supervisor
Works effectively with supervisor
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
Add option
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Answer key
(0 points)
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Acts with appropriate courtesy/professionalism toward colleagues and clients
Acts with appropriate courtesy/professionalism toward colleagues and clients
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Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
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…
Answer key
(0 points)
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Is punctual and maintains agreed-upon hours
Is punctual and maintains agreed-upon hours
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
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Multiple choice grid
Checkbox grid
Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
Add option
…
Answer key
(0 points)
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Participates effectively in the work environment
Participates effectively in the work environment
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
New
Multiple choice grid
Checkbox grid
Date
Time
1.
Unsatisfactory
2.
Improvement Needed
3.
Meets Expectations
4.
Exceeds Expectations
5.
Add option
…
Answer key
(0 points)
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What do I need to do or change to improve the second half of my experience or better prepare for this profession and the workplace? Please be as specific as possible.
What do I need to do or change to improve the second half of my experience or better prepare for this profession and the workplace? Please be as specific as possible.
Question Type
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File upload
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Rating
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Date
Time
Answer key
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I have met and reviewed the mid-point feedback with my supervisor.
I have met and reviewed the mid-point feedback with my supervisor.
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Time
1.
Yes
2.
No
3.
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Answer key
(0 points)
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