Agency/Organization where internship was completed:___________________________
On-Site Supervisor:______________________________________
Student intern:__________________________________________

Date of Internship: Fall _____ Spring _____ Summer _____

DIRECTIONS:

Your evaluation of the internship experience will assist us in placing future internship students in work settings which will enhance their development as counselors. Please circle the number which best represents how you feel about your experience.

1 - Poor
2 - Fair
3 - Adequate
4 - Good
5 - Excellent

1. Adequate physical work space was provided for me.	1 2 3 4 5
2. Adequate orientation to the work setting was given.	1 2 3 4 5
3. The supervisor helped me to define and achieve specific concrete goals during the internship experience	1 2 3 4 5
4. I was accepted and respected as a person.	1 2 3 4 5
5. The supervisor willingly gave time and energy to facilitating my development as a counselor.	1 2 3 4 5
6. I received constructive feedback (positive and negative)	1 2 3 4 5

Overall, would you recommend that this internship site be used again? Yes No

Additional comments: