Field Experience Evaluation Form
Missouri Western State University
______
Student’s Name Name of Agency Date
Instructions: Please place a mark in the column which you consider best rates the student.Do not return this form to the student. As a guide, the following definitions may be used when rating the student:
4 Superior Consistently demonstrates a high degree of achievement.
3 Above Average Demonstrates the trait above the level of peers.
2 Average No better or worse than peers.
1 Below Average Seems to lack the particular trait or demonstrates it less frequently than peers.
0 Unsatisfactory Not acceptable performance.
NA Not applicable
4 / 3 / 2 / 1 / 0 / NA / Comments1. PROFESSIONAL PREPARATION and skill and
knowledge for the position.
2. PARTICIPATION: Prompt, dependable,
prepared.
3. ORIGINALITY: Initiative, resourceful,
imaginative.
4. JUDGMENT: Evaluates in a reliable manner.
Common sense.
5. EFFECTIVE USE OF DISCIPLINE:
Fairness/control of situation.
6. COMMUNICATION SKILLS: ORAL
WRITTEN
7. LEADERSHIP: Responsible, organized.
8. RAPPORT/COORDINATION: with supervisor
and fellow workers.
9. ADAPTABILITY
10. INTERACTIONS WITH CLIENTS: Ability to
motivate, enthusiasm.
11. PERSONABLE: Sociable, pleasant.
12. EMOTIONAL MATURITY: Stable
13. PERSONAL CONDUCT: Manners, courteous,
considerate.
14. PERSONAL APPEARANCE: Neat
15. CAPACITY FOR FUTURE
PROFESSIONAL SUCCESS
Field Experience Evaluation Form, Continued
INTEGRITY: Honest in personal, professional and intellectual matters: Please check the most appropriate
response.
_____ Questionable (Explain below in “other comments”)
_____ No reason to question to the best of my knowledge.
_____ Through some event or circumstance had demonstrated high personal standards (Explain below in
“other comments”).
What grade would you assign to the student for this experience? A___B___C___D___F___.
REMARKS: Please use the following space for comments you may care to make.
Strengths of Student/Intern:
Areas of Improvement:
Other Comments:
Optional: If you had an opening available in the area of responsibility the intern has held, would you hire this individual?
YES_____ NO_____
I have discussed this evaluation with the student. YES_____Student Signature______
NO_____
Name of Supervisor Title Date
AGENCY’S ADDRESS
______
Supervisor’s Signature
Please return this Form to:
Mr. Greg Kriewitz
MissouriWesternStateUniversity, HPER Dept.
4525 Downs Drive
St. Joseph, MO64507
Office: (816) 271-5943
Fax: (816) 271-5940
Email:
MissouriWesternStateUniversity is an equal employment and educational opportunity institution.