Mid-term Evaluation

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Job Information

Fisher Institute for Wellness
and Gerontology
HP, PL 225
Phone: 888-935-5278
(toll free) or
(765) 285-8259
Fax: 765-285-8237
dsheller@bsu.edu

The John and Janice Fisher Institute for Wellness and Gerontology

Mid-term Evaluation

This evaluation is designed to provide structural feedback for the Intern, the Internship Supervisor, and the Program Director of Wellness Management on the Intern's progress.

This form is to be completed by the Intern and the Internship Supervisor. Assignments and evaluations should be submitted through this site. If you prefer to mail or fax forms please send them to the Program Director of Wellness Management by the specified due dates. The current address and telephone numbers are:

Dr. Jane Ellery
Associate Director
Program Director of Wellness Management
Fisher Institute for Wellness and Gerontology
Ball State University
2000 University Avenue
Muncie, Indiana 47306
(765) 285-8259 Main Office (765) 285-8237 Fax

Items with an * indicate a required field.

Today's Date *
Due Date *

Intern Information
Intern's Name *
Address *
City *
State *
Zip *
Country
Phone *
Fax *
E-mail address *

Internship Supervisor Information
Internship Supervisor's Name *
Title *
Internship Site *
Address *
City *
State *
Zip *
Phone *
Fax *
E-mail address *

Please select the measure that best describes the intern's ability in each of the following performance categories.
Quality of Work *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Quantity of Work *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Knowledge of Assignments *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Professional Conduct *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Cooperation *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Follows Instructions *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Assertiveness *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Initiative *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Small Group Process *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Management Skill *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Leadership Skill *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Time Management *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable
Communication Skills *	Excellent Very Good Good Satisfactory Unsatisfactory Not Applicable

Please list and describe the following:
Intern's Strengths *

Intern's Areas for Growth *

Intern's Comments *

Intership Supervisor's Comments *

Internship Supervisor has approved worksheet *	Yes No
Intern has approved worksheet *	Yes No
Date *