Fillable Form 5.: End of Semester Evaluation Instructions and (California State University, Fullerton)

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Form 5.: End of Semester Evaluation Instructions and (California State University, Fullerton)

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1
Revised 7/20
End of Semester Evaluation Instructions and
Evaluation Verification Form
1.
Complete the evaluations once your 120 hours have been completed (virtual OR on-
site).
2.
Review Online Evaluation Instructions (all links provided below).
3.
Print out the End of Semester Evaluation Verification Form (on page 2 of this
document). Make a virtual appointment to discuss your final evaluation with your
supervisor at the end of the semester. Your supervisor will discuss your evaluation
and provide feedback.
4.
Signatures are required on the 2
nd
page of this document (yours and your supervisor).
A typed signature will suffice during the Fall 2020 semester.
5.
SUPERVISOR INSTRUCTIONS:
Ask your supervisor to complete the online evaluation of your performance on
Survey Monkey (https://www.surveymonkey.com/r/CCLHNJ7). Let your
supervisor know that the evaluation needs to be done all in one sitting. Work
cannot be saved. The supervisor needs to click the DONE button when finished
completing the survey. The survey will be entered online.
6.
SUPERVISOR AND AGENCY EVALUATION INSTRUCTIONS:
Complete the evaluation of your supervisor and agency on Survey Monkey
(https://www.surveymonkey.com/r/H3T6JPL). Please click the DONE button
when finished so that the results will be entered online.
7.
FIELDWORK OFFICE EVALUATION INSTRUCTIONS:
Complete the evaluation of the Fieldwork Office on Survey Monkey
(https://www.surveymonkey.com/r/5W5VSW3). Please click the DONE button
when finished so that the results will be entered online.
8.
Ask your supervisor to complete his/her portion of Review the End of the
Semester Evaluation Verification Form and to rate your overall performance.
9.
Select the check-boxes that you have completed both surveys and sign your
name on the evaluation verification form.
10.
Check off that you are either in agreement or not in agreement with your
evaluation. This does not affect your grade if you disagree. Save this form to your
desktop.
11.
Turn this form electronically along with the Hourly Recording Form, showing
completion of at least 120 hours (with your supervisor’s signature) to your seminar
instructor to get credit for the course. If hours are not done by the end of the
semester, alert your instructor and you will receive an INC in the course. Once the
hours are completed, ask your instructor to complete a grade change. Turn in all
final paperwork to your instructor.
2
Revised 7/20
End of the Semester Evaluation Verification Form
Instructions to Supervisor: Please complete the online evaluation of your student’s (intern)
performance at your agency. Ask your intern for the website to complete the online evaluation.
Please provide verbal feedback to the student on areas of strength and future areas of growth during
your last meeting. Rate the student below and complete your fillable signatures. Send this form
back to the student after you have completed so the student can send to her instructor.
❑ I (
) have completed and submitted the online
evaluation of the student that I have supervised
S
uper
v
i
s
or
’
s
S
i
gnat
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e
Date
Overall rating of student’s performance:
❑ Outstanding
❑ Above Average
❑ Satisfactory
❑ Below Satisfactory
❑ Unsatisfactory
Instructions to Student:
Please meet with Supervisor to get feedback on your performance over the
course of the semester. Set up a final meeting time to discuss your progress. Sign below and
return this completed form to your instructor, along with your 120 hours signed off by your
supervisor (A digital signature is acceptable).
Student Name Date
S
uper
v
i
s
or
’
s
N
ame
C
l
a
s
s
(
day
/
t
i
m
e)
❑ I have completed and submitted the online Evaluation of Agency and Supervisor.
❑ I have completed and submitted the online Fieldwork Office Evaluation.
S
t
udent
’
s
S
i
gnatur
e
STUDENT REVIEW OF EVALUATION
My field supervisor and I have discussed this evaluation.
❑ I agree with the overall rating given above
❑ I do not agree with the overall rating above
NOTE:
If student disagrees with this evaluation, he/she should explain in writing and submitcopy to
the Fieldwork Supervisor and Internship Instructor.
S
t
udent
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D
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Form 5.: End of Semester Evaluation Instructions and (California State University, Fullerton)

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Completed 14 May 2021

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