Student Self Evaluation Form

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STUDENT INTERN SELF EVALUATION FORM (Form C)

Student Name: _______________________ Dates of Internship: ____________________


Student Phone: _______________________ Internship Site:________________________
Student Email: _______________________ Supervisor Name: _____________________

Please take a few minutes to evaluate your performance at the internship site.
Please evaluate yourself in comparison to other student interns/employees.

PART ONE: PERRFORMANCE REVIEW

Please rate your performance by checking the box that corresponds with your assessment of your performance in the
current internship.
Rating Scale:

Excellent =5 Performance significantly above proficiency level


Above Average = 4 Performance above proficiency level
Average = 3 Proficient performance
Improvement Needed = 2 Performance below proficiency level
Unsatisfactory = 1 Performance requires considerable improvement
Not Applicable =NA Not applicable in this internship experience

WORK RELATED PERFORMANCE


5 4 3 2 1 NA
1. Work attitude (ex. Initiative, enthusiasm)

2. Academic preparation

3. Problem-solving ability

4. Adaptability

5. Overall attendance

6. Progress towards learning goals

ORGANIZATIONAL SKILLS
5 4 3 2 1 NA
7. Time management skills

8. Planning skills

Form continued
RELATIONSHIPS WITH OTHERS
5 4 3 2 1 NA

9. Willingness to cooperate with co-workers

10. Ability to work with supervisor

11. Acceptance of constructive comments

12. Ability to take direction

COMMUNICATIONS SKILLS
5 4 3 2 1 NA

13. Oral communication skills

14. Written communication skills

15. Listening skills

5 4 3 2 1 NA

OVERALL RATING

PART TWO: ACCOMPLISHMENTS


Please provide the following information about your internship experience. If additional space is needed, please attach
an additional page to this evaluation.
1) Identify the most important learning goals you had set for yourself when beginning the
internship.

2) How well do you feel you accomplished these goals in this internship?

3) List the activities that allowed you to accomplish your goals.

4) Identify any specific knowledge or skills gained during this internship that have enhanced your professional
development.

5) Describe any noteworthy accomplishments you achieved during this internship.

Student Signature:_______________________________________ Date:____/____/_____

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