Please complete the information below:    

Experience start date:		Experience end date:
Intern Name:
	(Last)	(First)	(Middle)
Intern Email:

Supervisor Name:
	(Last)	(First)	(Middle)

Supervisor Title:
Agency Name:

General Assessment: 

1. What were your primary responsibilities?

2. Did you fulfill your work objectives?

3.What was your most significant accomplishment or satisfying moment during the experience?

4. If there has been a frustrating aspect of the job or a significant failure, what is it?

5. How did your work experience relate to your past academic experience?

.6. Would your recommend this internship site to another student? If not, why not?