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* 1. Name

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* 2. Email

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* 3. Title

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* 4. Name of Student Supervised

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* 5. Please rate the student on the characteristics listed below using the following scale:

A= Above Average
B= Average
C= Below Average
F= Low

  A B C F
Initiative
Dependability
Decision making skills
Interactions with colleagues
Interactions with clients
Desires to learn more
Professional appearance
Quality of work
Attitude
Professionalism
Communication skills
Overall rating

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* 6. Please comment on the student’s strengths.

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* 7. Please comment on the student’s areas for improvement.

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* 8. Please provide any other comments about the student not already covered.

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* 9. Do you believe our School has adequately prepared this student for professional work? If not, why?

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* 10. Do you have any thoughts on improving our practicum?

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* 11. Would you be willing to host students in the future?

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