Student is responsible for completing this form and retrieving signatures. Once your final version is complete, make three copies.
Retain one copy and provide copies to your faculty adviser and site supervisor. Submit the original signed agreement to the Career
Services Center (SSC 3258) before the internship begins.
Student Name Date
Employer Name Supervisor Name
To be completed within two weeks of the starting date of the co-op/internship experience.
Rate your current skill level. Work to improve these important employment skills during your internship.
Student Signature Supervisor Signature
The site superviser is encouraged to contact the faculty adviser or program manager to discuss progress.
Career Services Center | SSC 3258 | 425 Fawell Blvd. | Glen Ellyn, IL 60137-6599 | (630) 942-2230
CARSERV-13-12210(R3/13)
College of DuPage
Student Initial Self Assessment
Communication Skills Skill Level Self Management Skills Skill Level
Examples: Demonstrate oral communication
skills required; write clearly and concisely;
be willing to speak up, communicate
information, and ask for clarification; listen to
feedback and act to improve.
Exceptional
High
Average
Limited
Poor
Examples: Produce high-quality, error-free
work; adapt strategy when current approach
is not effective; use good judgment and
establish priorities; give attention to time
management, attendance and punctuality.
Exceptional
High
Average
Limited
Poor
Problem Solving/Decision Making Skills Skill Level Leadership/Initiative Skills Skill Level
Examples: Analyze situations and take
appropriate action; offer creative solutions
to problems; collect and analyze information
to do a task and establish a course of action
in a timely manner; resolve problems within
appropriate time frame.
Exceptional
High
Average
Limited
Poor
Examples: Seek opportunities to learn; take
appropriate action to get the job done;
complete work despite obstacles; set goals
and follow up.
Exceptional
High
Average
Limited
Poor
Teamwork Skills Skill Level Technical Skills Skill Level
Examples: Make a positive impact on work
team by establishing rapport and credibility;
share information and resources with others;
pitch in to help co-workers; be willing to put
in extra time and effort to get the job done.
Exceptional
High
Average
Limited
Poor
Examples: Possess the technical skills
required for the position; be willing to
enhance technical skills; use technology
appropriately to perform work effectively.
Exceptional
High
Average
Limited
Poor
