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SPONSORING SCIENTIST'S EVALUATION REPORT ON STUDENT'S PROGRESS

Student's Name: __Steven Qu________________________________________________________


Sponsoring Scientist's Name:_______Zhengyi Cheng_______________________________________
Address of Internship: ______8301 Arlington Blvd Ste 502_______________________________
City Fairfax_________

State VA

Zip Code__22031_______

Field of Internship (pediatrics, animal medicine, etc.) _____Family Medicine___________________


EVALUATION:
0=No comment, no opportunity to observe
3=Average
1=Generally weak
4=Above Average
2=Below average
5=Excellent
1. Planning and preparation for the internship

2. Punctuality

3. Initiative

4. Responsibility

5. Helpfulness

6. Interest in learning

7. Ability to apply knowledge

8. Interpersonal relationship

9. Conscientious

10. Organization

Additional comments

Would you be willing to mentor a student next year? yes

no

Signature of evaluator _________________________________________


Printed name
_______________________________________________
Please note: Please return this form in the attached envelope to:
Ms. Karen Conboy, 4700 Stonecroft Blvd. Chantilly, VA. 20151

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