Name of Intern:_______________________________________________________
Name of Internship Organization:_________________________________________
Location/Address of Organization:_________________________________________
Name of Supervisor:____________________________ Phone:( )_____________
To the Supervisor: Please write a statement concerning the intern's performance in your organization. It would be helpful if you could include a general description of the duties performed and an indication of the intern's strengths and weaknesses relating to both personal and professional matters.
(Use the back, or include attachments if more space is needed.)
Do you have any specific suggestions that would enhance the intern's development?
Please estimate the usual number of hours per week that the intern served your organization: _______
Internship period: Start_______________________ End______________________
Supervisor's Signature & Date
Please return this form to Dr. Albert Gardner at the address below.