Field Experience Site Supervisor Feedback Header Image

Site Supervisor Experiential Learning Feedback

(Job Shadow or Course-Related)

Section A: Supervisory Information

 

Student Name:*
Site Supervisor:*

Section B: Skills Assessment

Use the following scale to assess your participant (student). Add comments when appropriate.

5 = Exceptional - Engagement and participation levels far exceeded normal expectations of the student, demonstrating consistent eagerness and inquisitiveness to learn from the experience.

4 = Effective - Attention and participation frequently exceeded expectations and were generally sustained throughout the experience.

3 = Competent - Participation clearly and fully met all the requirements of the experience (i.e., job shadow or course experience).

2 = Developing - Participation met most requirements but struggled to either meet all requirements or sustain consistent participation (needed to develop).

1 = Unsatisfactory - Participation needed to improve substantially.

N/A = Not Applicable

COMMUNICATION - Demonstrates oral communication skills required for the experience; writes clearly and concisely; asks questions; actively listens to feedback*
PROFESSIONALISM - Exhibits a self-motivation; demonstrates the ability to set appropriate priorities/goals; displays appropriate behavior*
CHARACTER & HABITS - Reports to the experience as scheduled and on-time; exhibits a positive and constructive attitude; brings a sense of values and integrity to the experience; dresses appropriately for the experience*
TEAMWORK - Establishes rapport and credibility among team members; shares information and resources with others; assists and cooperates with others; demonstrates a willingness to put forth the extra effort*
SELF-MANAGEMENT - Seems mindful of the environment (including the client); seeks new knowledge, approaches, or strategies; prioritizes and uses time efficiently; demonstrates ethical behavior*
INITIATIVE - Seeks opportunities to learn; takes the initiative to ask questions; tries to overcome obstacles and problems; sets goals; follows through on expectations*
TECHNICAL SKILLS - Possessed the technical skills required for this experience; learns new skills and enhance existing skills; uses appropriate technology for tasks; uses technology to perform effectively*

Section C: Overall Experience

Skills the student observed and/or learned through this experience: (Please check at least 3.)

Likely Success

(If I were to rate the student at present to succeed in an entry-level job)

Overall Engagement

(If I were to rate the student’s engagement in the experience)

I discussed the student’s performance in a one-on-one meeting:*
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Date:*
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