<p> INTERNSHIP EVALUATION REPORT Students cannot receive a grade for the internship until this completed form is returned. The FAX# for the Department is 484-646-4180. Thank you.</p><p>Intern:______Date:______</p><p>Client:______Phone:______</p><p>Address:______</p><p>City, State, Zip:______</p><p>Client Supervisor:______</p><p>Evaluation Period: From:______To:______</p><p>______</p><p>1. What were the Intern’s duties during the evaluation period?</p><p>2. What was the quality of the work performed?</p><p>Excellent Fair Poor X X X X X</p><p>Comments:</p><p>3. How would you characterized the Intern’s RESPONSIBILITY and DEPENDABILITY?</p><p>Excellent Fair Poor X X X X X</p><p>Comments:</p><p>4. How would you characterize the Intern’s EFFORT and ENTHUSIASM?</p><p>Excellent Fair Poor X X X X X</p><p>Comments: 5. What other comments about this Intern’s performance are important? Able to work with others? Able to assume responsibility? Able to innovate? Able to communicate orally and in writing</p><p>6. What are this Intern’s major strengths and weaknesses in your opinion?</p><p>7. What would you suggest this Intern do to improve his or her effectiveness?</p><p>8. Would your organization be interested in working with another Intern from Kutztown University? If no, why not?</p><p>9. Additional comments and/or suggestions?</p><p>Supervisor’s Signature:______Date:______</p>