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Faculty Internship Report Form
* Student Intern Name
 
* Term
  Fall     Spring     Summer    
* Year
 
* On-site Visit
  Yes
No
If yes, date of visit (mm/dd/yy)
 

Internship Site
 
* Company/Organization
 
Street
 
City
 
State
 
Zip Code
 
* On-site Supervisor
 
* Nature of Internship
 

Report on student's internship experience
 
* Student’s general satisfaction with internship experience
 
* Is support and on-site supervision adequate?
  Yes
No
Comments
 
* Has substantial work or projects been assigned?
  Yes
No
* Examples
 
* Learning as expected?
  As expected
More than expected
Less than expected - please explain below
Comments
 
* How are relations with fellow workers and superiors?
 
* Is general atmosphere at the workplace agreeable, friendly?
  Yes
No
Comments
 
Further comments regarding student's experience
 

Report on site supervisor's satisfaction with student
 
* Overall satisfaction with intern
 
* Work habits of the intern are satisfactory
  Yes
No
Comments
 
* Intern shows reasonable sense of responsibility/dependability
  Yes
No
Comments
 
* Intern applies himself/herself to developing skills in task performance
  Yes
No
Comments
 
* Attitudes of the intern are healthy and positive
  Yes
No
Comments
 
* Intern’s skills in human relations are satisfactory
  Yes
No
Comments
 
Further comments regarding site supervisor's satisfaction with student
 
* General remarks/observations
 
Report completed by:
 
* Faculty Internship Supervisor
 
* Campus Mailbox
 
* Email Address
 

Please print before submitting if you want a copy of this for your records.
 
* Required Fields
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