‘Step 3: End of Internship evaluation This form is to be filled at by the supervisor, and reviewed with student, when the student is complete ith their internship hours. Please rate interns based on thelr performance at your facility, not their knowledge coming in unless it is causing serious issues with expected internship duties bate: i | Hours Completed:_“ (On a scale below please rate your interns overall performance, please circle the rating Oise) eeet 2 3 4 5 (ileal mira a [(s>]| 10 i Very Very | Very | pg, | Below | a /o,apq| Above | Moderately Very worse | Neier [We [_reor_| serge || avaze| cond” | S244 | coou | ‘What are the top three areas they have done well in? 1. Chreot enyrymest 2 Aah qoratiors 3 Coveted Appeacacce. Did the student improve in areas needing improvement as discussed on Step 20 IN ‘Are there areas where the student can use further improvement? If so, where? Nes coll all of us, oe to aetar Kuewsheha. AS coll AS Keep op coth all pve eee aed poe toeseling Ave what is Ss ay) lel ae 44 return to instructor | ‘Once this evaluation has been discussed between supervisor and student please sign below and Student Signature ‘Supervisor Signature: