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Master of Public Health Internship Program
STUDENT EVALUATION FORM
Intern: FILLIN "Intern's name" \* MERGEFORMAT Insert name of intern here Semester/Year of internship: Sem/Yr
Agency: Insert name of agency here Preceptor: Insert name of preceptor here
TO THE INTERN: This evaluation is an opportunity for you to provide an open and honest assessment of your internship experience. Feedback provided in this evaluation will remain confidential. Your comments should reflect thoughtful consideration of your experience, and relevant criticisms or shortcomings of the experience should be presented in a constructive, forthcoming manner.
Please use an X to indicate your responses below.
Not Applicable
0Strongly Disagree
1Disagree
2Neutral
3Agree
4Strongly
Agree
5INTERNSHIP SITE1. The facility was adequate.2. This agency was clearly setup to have interns.3. The atmosphere at the agency was professional.4. I worked on my project with other interns/staff at the agency.5. I would consider accepting employment at this agency.PRECEPTOR1. Interns were encouraged to ask questions and/or give opinions.2. The preceptors development and presentation of material were consistent with the goals of the internship.3. The preceptors presentation of materials was of the highest quality level.4. The preceptor was accessible and concerned about the interns progress.5. The preceptors overall capability was of the highest quality level.
Orientation and planning of internship:
1. Was the rationale for your tasks adequately explained?
2. Were the tasks assigned to you instructive?
3. How clear was the relevance or significance of the major project to the overall field of public health? Please Explain:
4. Was the overall internship experience useful to you in terms of your future career goals?
Extremely Helpful____ Usually helpful___ Somewhat helpful___ Not helpful____
Please Explain:
5. Check the one that is most applicable and explain.
____a. I would recommend this internship/field placement to other students without reservations.
____b. I would recommend this internship/field placement to other students with the following revisions:
____c. I would not recommend this internship/field placement for the following reasons.
Please Explain:
6. Did you feel capable of handling all the responsibilities assigned to you?
7. In what areas do you feel your education was beneficial in preparing you for your internship?
8. How did your internship experiences differ from your expectations?
9. What was the most valuable aspect of your internship?
Please use the space below if you would like to provide additional information about the internship experience:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Students signature Date
Thank you!
Your responses are important for the ongoing development of the internship program. Your feedback may be used to guide development of future internship placements, but will remain anonymous.
Please submit completed form to:
Dr. Patricia Cruz, MPH Internship Coordinator
Rod Lee Bigelow Health Sciences (BHS) 516
Email: patricia.cruz@unlv.edu
Phone: 702-895-1417
MPH Internship Student Evaluation
Revised 2/25/16
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