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* 1. Cal Poly Intern Name:

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* 2. (Your) Supervisor Name:

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* 3. Supervisor Title:

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* 4. Supervisor Phone and Email:

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* 5. Company Name:

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* 6. Internship start date?

Date

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* 7. Internship completion date:

Date

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* 8. What were the total hours worked by this intern?

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* 9. What do you feel were the primary strengths of this intern?

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* 10. What do you feel were the primary weaknesses of this intern?

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* 11. Would your company hire this intern for full-time employment, now or in the future?

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* 12. Generally speaking, are you satisfied that your company benefited from participation in the Internship program, insofar as it involved this student?

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* 13. What suggestions do you have, if any, for improving the internship program?

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