UM SPH Internship: Preceptor Evaluation An internship is a learning experience for students. Therefore, it is an advantage to the student to have performance evaluated in a way that will help identify areas of strength and opportunities for growth. Please evaluate the student on the parameters below, as compared to an entry-level professional in your field.

Internship Information

Student: Name

Briefly describe the project(s) that the student worked on.

Please include 2-3 sentences.

Hours

Add Item

Total Hours

How many hours will the student complete?*

Please provide the total hours expected at the end of the internship.

318+ hours 424+ hours 530+ hours 636+ hours Other

Learning and Development Assessment Please rate how well the student demonstrated skills in the following areas:

Project/program planning and design*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Project implementation*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Project evaluation/assessment *

Poor

Communication (verbal and written)*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Policy development/analysis*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Fair

Good

Very Good

Excellent

Not Applicable

https://umichsph-csm.symplicity.com/...9jc20vQ0VOVFJBTC9DRU5UUkFMQ1NNXzIwMTVfMDQvaW5jbHVkZS9zZXR1cC5pbmM%3D[5/6/2015 1:59:37 PM]

Data collection and synthesis*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Data utilization in decision making*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Application of Public Health principles and theories*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Competence in working with

diverse audiences*

Leadership and initiative*

For example: researchers, practitioners, agencies, and organizations

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Excellent

Not Applicable

Any additional comments on skills the student acquired or demonstrated beyond what is listed above?

Assessment of Professionalism Please evaluate your perception of the student's professional capacities (as relevant):

Ability to adapt and be flexible with changing situations*

Poor

Works well in teams *

Poor

Works well independently*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Ability to effectively manage time*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Has an accurate understanding of his/her own strengths and challenges*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Ability to accept feedback*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Demonstrates team building, negotiation, and conflictmanagement skills*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

Fair

Fair

Good

Good

Very Good

Very Good

Excellent

Not Applicable

https://umichsph-csm.symplicity.com/...9jc20vQ0VOVFJBTC9DRU5UUkFMQ1NNXzIwMTVfMDQvaW5jbHVkZS9zZXR1cC5pbmM%3D[5/6/2015 1:59:37 PM]

Ability to present to a diverse audience*

Poor

Fair

Good

Very Good

Excellent

Not Applicable

In what area would improvement be most valuable for this student?*

Work Assessment Please rate the following statements about the quality of student performance.

The student was prepared to complete his/her learning objectives in our

agency/organization.*

Strongly Agree

The student accomplished the agreed-upon learning objectives.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

There was demonstrated personal and/or professional growth in the student's performance over the course of the internship.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

I would recommend the student for a position in our agency/organization or a similar

agency/organization.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

The student demonstrated knowledge of public health and/or public health systems.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

Overall rating of the student's performance.*

Agree Neutral Disagree Strongly Disagree

Excellent Very Good

Additional comments on the student's skills or professional performance during the internship

https://umichsph-csm.symplicity.com/...9jc20vQ0VOVFJBTC9DRU5UUkFMQ1NNXzIwMTVfMDQvaW5jbHVkZS9zZXR1cC5pbmM%3D[5/6/2015 1:59:37 PM]

Assessment of Overall Experience Please rate your agreement with the following statements about your experience with the internship.

My organization was prepared to host an intern.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

There was good communication between the student and myself.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

The goals of the internship were clear to me.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

I anticipate we will host another UM SPH intern in the future.*

Strongly Agree Agree Neutral Disagree Strongly Disagree

Comments or suggestions to make it easier to host UM SPH interns*

Select "Save" to submit the UM SPH Internship Evaluation. You may select "Save As Draft" to finish the evaluation at a later time.

Thank You We appreciate you extending an internship opportunity to a University of Michigan School of Public Health (UM SPH) graduate student. Thank you for serving in this important role, and enhancing the student's academic career. A copy of this evaluation will be available for the student to view.

https://umichsph-csm.symplicity.com/...9jc20vQ0VOVFJBTC9DRU5UUkFMQ1NNXzIwMTVfMDQvaW5jbHVkZS9zZXR1cC5pbmM%3D[5/6/2015 1:59:37 PM]