Online Survey Software | Qualtrics Survey Solutions Page | of 10 Your responses to the following items will provide the student with feedback about his or her strengths, as well as those areas in which improvement was made from the midterm point to now. In order to be most effective, PLEASE share this evaluation with the interns. As you know, the internship program is an A-F graded experience. As such, the midterm evaluation will eventually be worth 10% of the student's grade. The items below that require you to rate the student from "Strongly Disagree to Strongly Agree" have noted point values. There is a space at the bottom of each section for you to add up the points ***When "Non Applicable" is selected, please average your responses and add those points so the student does not lose points. For example, if the student earned mostly 4's, then add 4 points per Non Applicable selection to the total point value for that section. To help you assess the student appropriately, here are some guidelines for the scales concerning professionalism, work ethic and interpersonal skills: Strongly Disagree: the student never exemplifies the characteristic Disagree: the student rarely does Neutral: the student occasionally does; they may show progress in an area, but are still working on it Agree: the student is a hard worker who demonstrates commitment and growth hups://ugeorgia.qualtrics.com/jfe/form/SV_bIYPiatoevijftr 3/30/2017Online Survey Software | Qualtrics Survey Solutions Strongly Agree: the students is phenomenal and meets or exceeds your expectations most of the time | welcome and encourage your feedback as you complete this survey, Page 2 of 10 particularly in regards to the scales. This evaluation is a working document that | am always striving to improve. As part of this process, I've included a rubric. below so you understand what the point values translate to in regards to a grade F 0-4=1 point 5-14=2 points 15-24=3 points 25-34=4 points 35-44=5 points D 45-54=6 points c 55-64=7 points B 65-74=8 points A 75-85=9 points 86-100=10 points Thank you for your assistance. Date hups://ugeorgia.qualtrics.comi/jfe/form/SV_bJY Piatoevijftr 3/30/2017Online Survey Software | Qualtrics Survey Solutions Page 3 of 10 Month Day Year Please Select | March vj 30 2017 vj Internship Site Fanning Institute Semester Spring Vv} Year 2017 V| Your Name David Meyers Student Intern's Name Zoe Williams Please comment on the student inter’s professionalism. Response Scale omega Disagree Neutral Agree Strongly Not (0) a) (2) (3) Agree (4) Applicable Arrives promptly and O° ° oOo ° Oo regularly 0 O° Oo Oo ° Oo hutps:/ugeorgia.qualtrics.comi/fe/form/SV_bIY Piatoevijfir 3/30/2017Online Survey Software | Qualtrics Survey Solutions Page 4 of 10 { Response Scale DeeneY, Disagree Neutral Agree Strongly Not ‘O (1) (2) (3) Agree (4) Applicable Presents a ee a _ professional appearance Respects | confidentiality ° ° o.0°08 e O° Adheres to agency guidelines and ° Oo OHO. e Oo policies Willing to accept and use suggestions ° ° Oo Oo @ O° Shows openness to self-evaluation ° ° Oo Oo © ° Asserts own views and concerns ° O° Oo O° © Oo effectively Is able to express feelings, both negative and positive ° ° O° e) e ° Please provide comments to clarify or explain your responses. Zoe exudes professionalism and has been a great addition to our office environment Point Total (please add the points from your responses in the above scale) 32 Please comment on the student intern's work ethic. hhups://ugeorgia.qualtrics.com/jfe/form/SV_bJY Piatoevijftr 3/30/2017ss Online Survey Software | Qualtries Survey Solutions Page 5 of 10 Response Scale | DeeraY, Disagree Neutral Agree Strongly Not ‘O ()—@)— Agree (4) Applicable “Has needed knowledge |G) +H base in topic area | Oo ° Oo 0 90 ° Demonstrates interest in and commitmenttothe | © O° o Oo Oo ° agency | Demonstrates understanding of the purpose and function of O ° o 9° 9° ° the agency Demonstrates active desire to learn from and | contribute to placement ° ° oo ° ° organization Is a self starter and functions autonomously ° ° o °o ° ° Develops alternative tasks when prior expectations or goals ° ° ° ° ° ° are not met Willing to ask others for ee o 0 0 0 0 ° Is cooperative, flexible and adaptable ° ° ° ° ° ° Completes assignments ‘on time ° ° ° ° ° ° Work is organized ° ° Oo Oo Oo Oo Communicates effectively when ° O° Oo Oo O° O° speaking Communicates 1 fo) O oO ° °O O° effectively when writing | Please provide comments to clarify or explain your responses. hutps: /ugeorgia.qualtries.com/jfe/form/SV_bIY Piatoevijftr 3/30/2017Online Survey Software | Qualtrics Survey Solutions Page 6 of 10 Nothing but positives for Zoe, She has done excellent work and has demonstrated initiative when appropriate. Point Total (please add the points from your responses in the above scale) 47 Please comment on the student inter's interpersonal skills. Response Scale Strongly Disagree 0) Disagree Neutral Agree Strongly Not (1) (2) (3) Agree (4) Applicable Seeks to establish rapport with the fo} oO Oo oO Oo Oo practicum supervisor Seeks to establish rapport with the Oo O° Oo Oo Oo agency staff Seeks to establish rapport with clientele ° ° o oO Responds to various | cultural, ethnic, and fe} ° Oo oO oO gender needs, Please provide comments to clarify or explain your responses. Zoe has demonstrated a strength in developing relationships throughout the agency. huips://ugeorgia.qualtrics.com/jfe/form/SV_bIY Piatoevijttr 3/30/2017—— Online Survey Software | Qualtrics Survey Solutions Page 7 of 10 Point Total (please add the points from your responses in the above scale) 16 Did the student intern share their learning goals, objectives, and project ideas with you? Yes No If you answered yes, how has the student intern worked towards meeting and/or completing these? very independently. She has developed a handbook for high school students that will become a complement to our training materials. How has the student intern adjusted to their role as an intern with new circumstances, expectations and people? ‘seemlessly. Fanning can be a hard place to integrate into - she has done so by being inquisitive, willing, and perceptive What are the student intern's major strengths? hups:/fugeorgia.qualt comijfe/form/SV_bIYPiatoevijfir 3/30/2017Page 8 of 10 Online Survey Sofiware | Qualtrics Survey Solutions independent, reliable, on time, smart and perceptive, takes initiative, sees opportunities and fills gaps as needed. Zoe is happy to do the small tasks as well as the bigger picture tasks. In what areas could the intern improve? She has been everything that we could have hoped for - she exemplifies what we would like in our interns. How would you rate the student intern's performance at your organization? Needs Inadequate Improvement Above (0) a) Average (2) Average (3) Superior (4) Performance fe) ° ° ° oO Final Point Value (please add the points from the 3 scales, as well as the overall rating score immediately above to calculate a score out of 100) 99 : i Please provide any additional comments that would improve the experience for you and the intern. Zoe has been an excellent performer in our office - I wish we could have many just like her in the future! https:/ugeorgia.qualtrics.com/jfe/form/SV_bJY Piatoevijfir 3/30/2017Online Survey Software | Qualtries Survey Solutions Page 9 of 10 Would you like this evaluation to remain confidential? (Please understand that the student will see their point total in the grade book.) Yes No Have you discussed this evaluation with the student intern? Yes No | will print a copy for my records Please print before submitting. An electronic copy can be saved by: selecting file, print, and pdf as the destination, If itis not an option, you can download a free pdf printer at pdf995.com, PDF Creator and CutePDF. If an electronic copy is not possible, then just print to paper. If you do not print a copy, an excel format is the only one | will be able to provide you Yes No hups://ugeorgia.qualtrics.convjfelform/SV_bIYPiatoevijfir 3/30/2017