Fillable ExerciseScienceHandbookAppJ APPENDIX H

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ExerciseScienceHandbookAppJ APPENDIX H

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APPENDIX J
UNIVERSITY SUPERVISOR EVALUATION
Instructions:
This form is to be completed by the student and submitted to the address identified at the end of the form.
This form will be kept confidential from the university supervisor until the end of the academic year and
until at least five such forms are accumulated.
Name:_______________________________ Date:___________________
Site of Internship:_________________________________________________________
Please answer each of the following questions. If you need additional space, attach separate sheets. At no
time will the supervisor see the original evaluation from the student. All information will appear in
aggregate format based on at least five evaluations. All final grades will be posted before any internship
aggregate evaluation information will be shared with the university supervisor. All evaluation feedback is
completely confidential and the university supervisor will not be able to identify the source of any
comment.
Please circle the appropriate response for each statement.
1) The university supervisor distributed the internship manual.
Strongly Agree Agree Disagree Strongly Disagree
2) The university supervisor went over the internship manual.
Strongly Agree Agree Disagree Strongly Disagree
3) The university supervisor notified me of all logs, reports, journals or other required assignments that
were part of the successful completion of the internship.
Strongly Agree Agree Disagree Strongly Disagree
4) The university supervisor informed me of all due dates for the required assignments that were part of the
successful completion of the internship.
Strongly Agree Agree Disagree Strongly Disagree
5) The university supervisor completed evaluations as specified in the internship manual.
Strongly Agree Agree Disagree Strongly Disagree
6) The university supervisor visited your site at least once during your internship.
Strongly Agree Agree Disagree Strongly Disagree
7) The university supervisor appropriately notified me for any missing assignments or for not
fulfilling my assigned duties in my internship.
Strongly Agree Agree Disagree Strongly Disagree
8) The university supervisor provided me with sufficient opportunity to interact either by email,
on site, or by phone.
Strongly Agree Agree Disagree Strongly Disagree
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9) The university supervisor communicated with me at a level consistent with my professional
development.
Strongly Agree Agree Disagree Strongly Disagree
10) The university supervisor was readily available to me in order to answer my questions or discuss any
concerns I might have about the internship.
Strongly Agree Agree Disagree Strongly Disagree
11) The university supervisor conveyed specific areas of strengths or weaknesses to me.
Strongly Agree Agree Disagree Strongly Disagree
12) The university supervisor showed respect for me as an individual during any conference or
evaluation?
Strongly Agree Agree Disagree Strongly Disagree
13) The university supervisor appropriately encouraged me to become an independent/
autonomous professional.
Strongly Agree Agree Disagree Strongly Disagree
14) The university supervisor maintained confidentiality about my performance during the
internship.
Strongly Agree Agree Disagree Strongly Disagree
15) The university supervisor encouraged me to initiate strategies for future professional
experiences.
Strongly Agree Agree Disagree Strongly Disagree
16) The university supervisor encouraged me to reflect on my internship experience.
Strongly Agree Agree Disagree Strongly Disagree
In the space provided below, please make any specific comments concerning the university
supervisor.
PLEASE RETURN THE COMPLETED FORM IN THE SELF-ADDRESSED ENVELOPE.
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ExerciseScienceHandbookAppJ APPENDIX H

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Completed 8 February 2020

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