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Mid-Term Evaluation of Student (MPH)

Mid-Term Evaluation of Student (MPH)

Field Experience in Public Health - To be completed by Site Supervisor

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General InformationStudent Fist Name*Student Last Name*Course Number*⁺Internship Supervisor Name*Internship Supervisor Email*Place of Internship*Reporting Period - Start Date*Reporting Period - End Date*Hours Worked During Reporting Period*Cumulative Hours Worked to Date*

I. Status of Objectives, as related to the Memorandum of Understanding and Competencies.Accomplished Activities:*Activities Still in Progress: *

II. Perception of Intern's Personal Attributes and Professional Skills

Please use the number below to indicate the intern's personal attributes and professional skills.

Competence in the JobDecision Making Skills*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Organizational Skills*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Knowledge*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Productivity*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Initiative*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Creativity*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Accuracy and Thoroughness*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Communication - Verbal*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Communication - Written*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:

ProfessionalismPersonal Appearance*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Attitude*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Punctuality*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Dependability*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Confidentiality*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Adaptability*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:

Interpersonal RelationsCommunity Relations*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Staff Relations*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Student Relations*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Empathy*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Cooperation*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Friendliness*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Listening Skills*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:

Personal AttributesEnthusiasm*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Persistence*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Assertiveness*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Maturity*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Motivation*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:Self-Confidence*

5 - Excellent

4 - Above Average

3 - Average

2 - Below Average

1 - Poor

N/A

Comments:

III. Evaluation of the performance of the internStrengths Detected*Areas for Improvement *

IV. Suggested Changes in Objectives, Future Activities, if any

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