Illinois Valley Community College


(Form to be completed by the intern and returned to the program coordinator

 at the end of the internship.)



NAME OF STUDENT __________________________________ DATE ___________________


INTERNSHIP SITE _____________________________________________________________  


SITE ADDRESS ________________________________________________________________            


NAME OF SUPERVISOR ________________________________________________________            


INTERNSHIP TIME PERIOD  _____________, 20_______  TO ______________, 20 ________




1.      Briefly state you internship experiences.







2.      List the positive aspects of your internship experiences.







3.      Are there any negative aspects of this internship experience that could be important to the next student?







4.      How would you rate the overall quality of your internship experience?

       (Check one)

             Excellent                Good                 Average                 Poor



5.      How do you feel about this internship related to :

A.     Understanding your career field of interest?







B.     To your academic coursework?






C.     To your individual growth as a person?






6.      Would you recommend this internship site for future interns?

(Check one)

           Yes               No







7.      Give your general comments about your internship experience.









STUDENTíS SIGNATURE  _____________________________ DATE ____________



COORDINATORíS SIGNATURE __________________________ DATE ____________