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Student Evaluation of Fieldwork Site and Agency Supervisor
Name of Agency:
Date you are completing this evaluation.
Enter date according to this format, MM/DD/YYYY. (EX: 04/09/2022)
Name of Program:
Agency Information (address & phone number):
Name & Title of Fieldwork Supervisor:
Student Name:
Semester/Year (EX: Spring/2022):
Internship Placement Course Number:
HUSR 396
HUSR 495
HUSR 496
On a scale from 1 to 5, with 1 being poor and 5 being excellent, how would you rate your placement/agency overall?
1
2
3
4
5
On a scale from 1 to 5, with 1 being poor and 5 being excellent, how would you rate your learning experience within the placement/agency?
1
2
3
4
5
What was the most valuable part of your experience at this placement?
What was the least valuable part of your experience at this placement?
Did supervision take place on a weekly basis?
Yes
No
On average, how many minutes per week were you supervised?
0 to 30
31 to 60
Over 60
Were you provided with individual supervision, group supervision or both?
Individual Supervision
Group Supervision
Both Individual & Group Supervision
On a scale from 1 to 5, with 1 being poor and 5 being excellent, how would you rate the supervision you received at your placement?
1
2
3
4
5
On a scale from 1 to 5, with 1 being never available and 5 being always available, how would you rate your site supervisor’s availability to you when you needed assistance?
1
2
3
4
5
On a scale from 1 to 5, with 1 being poor and 5 being excellent, how would you rate your learning experience directly with your site supervisor?
1
2
3
4
5
What were the strengths of your site supervisor?
In what areas do you believe your site supervisor needed improvement?
Any additional comments you would like to make about this agency or your site supervisor?
Would you recommend this placement to other students in the future?
Yes
Maybe
No
Please briefly explain your response to the above question.
Type your full name in the text box below.
Please sign below. Use your finger on a touch screen or your mouse to provide your signature below. Once you are done signing, simply click on the blue arrow to the right to submit the evaluation.
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