Supervisor's Evaluation & Hours Verification
Please complete the following information and verify the number of hours the Student Activity Fund (SAF) Student Intern volunteered at your agency. All information is confidential and helps us to better serve you and our students. By Printing your name you are confirming the total number of hours the Student Intern volunteered under your supervision. Thank you.
Your name & title *
Your answer
Telephone number *
Your answer
Name of Student Intern *
Your answer
Total number of hours Student worked *
Your answer
Beginning Date *
MM
/
DD
/
YYYY
Ending Date *
MM
/
DD
/
YYYY
Please evaluate the student intern in terms of the following: *
Outstanding
Good
Average
Needs a bit improvement
Reliability
Attitude
Ability to work independently
Willingness to follow directions
How well a fit with the Agency
Please provide a brief description of the intern's responsibilities? *
Your answer
Please describe any of the intern's strengths and/or weaknesses *
Your answer
Would you like to participate in the program again in the future? *
Anything else you would like the SAF Program Director to know?
Your answer
What is the demographic make-up of the agency's constituency?
Note: This question is requested by our grant funder and is for demographic tracking purposes only.
Over 75%
Over 50% & Under 75%
Over 25% & Under 50%
Less than 25%
N/A
People of Color
White
Average Income
Low Income
Indigent
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