Family Life Education Practicum
Supervisor Evaluation for Practicum

Intern Name___________________________________________________________________

Intern Job Title__________________________________________________________________

Agency Name__________________________________________________________________

Agency Address________________________________________________________________

Supervisor Name_______________________________________________________________

Supervisor Title_____________________________ Phone/Ext._________________________

Directions: Please rate the intern in the following categories

Superior
Good
Average
Poor

Management/Organizational Abilities

Leadership and Iniative
20
18
15
12
9
6
3
0
Motivation & Delegation Skills
20
18
15
12
9
6
3
0
Organizational & Planning Skills
20
18
15
12
9
6
3
0
Prioritizing Skills
20
18
15
12
9
6
3
0
Problem Solving Skills
20
18
15
12
9
6
3
0

Interpersonal Abilities

Communication Skills
20
18
15
12
9
6
3
0
Conflict Management Skills
20
18
15
12
9
6
3
0
Empathy Skills
20
18
15
12
9
6
3
0
Human Relation Skills
20
18
15
12
9
6
3
0
Resourcefulness
20
18
15
12
9
6
3
0


Professionalism/Related

Attendance & Punctuality
20
18
15
12
9
6
3
0
Attitude
20
18
15
12
9
6
3
0
Dependability
20
18
15
12
9
6
3
0
Initiative & Achievement
20
18
15
12
9
6
3
0
Judgement
20
18
15
12
9
6
3
0
Knowledge
20
18
15
12
9
6
3
0
Professionalism
20
18
15
12
9
6
3
0
Quality of Work
20
18
15
12
9
6
3
0

 

OVERALL PERFORMANCE
40
35
30
25
20
15
10
0


Total _____

Comments: __________________________________________________________________

______________________________________________________________________________

____________________________________________________________________________

.
Total hours worked from ________________ to___________________= _______ hours


_______________________________ _______ _____________________________ ______
Student Intern Date Supervisor Dtre