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Directions: This form is completed by the on-site supervisor at the end of the contracted semester and
discussed with the intern. A copy of this form should be provided to the University supervisor and
included in the Intern’s Portfolio.
On-site Supervisor: Dr. Gabrielle K. Gabrielli University Supervisor: _Dr. Atsusi Hirumi_
1. Self Awareness and Autonomy: For example, recognition of personal strengths and weaknesses;
clarity of personal values and attitudes; acceptance of responsibility for field learning; efficient use
of time; carrying out assignments with appropriate level of supervisory assistance; respecting
appointments, deadlines, and other commitments
Rarely meets expectation Generally meets expectation Occasionally exceeds expectations Frequently exceeds
expectations
COMMENTS: Becky has high levels of self-awareness and is good with autonomy, plus she is very good
with responsiveness to feedback. Her schedule was very busy including with schoolwork, so her time
was limited on important tasks and deadlines. I have no doubt she did the best she could with the time
she had, but I wish we had more focused time to work together.
Rarely meets expectation Generally meets expectation Occasionally exceeds expectations Frequently exceeds
expectations
COMMENTS: Becky worked on many different aspects of many different projects. I would not expect
her knowledge to span all areas, though she performed well with assigned tasks. Those tasks included
developing learning objectives, working on assessment instruments, and developing instructional
strategies as well as solutions including a job aid for a human performance improvement project.
3. Oral and Written Communication Skills: For example, clarity in written communication; appropriate
use of professional language and terminology; accuracy in necessary reports and notes; ability to
listen; willingness to express self in group meetings and case/staff conferences; public speaking skills
Rarely meets expectation Generally meets expectation Occasionally exceeds expectations Frequently exceeds
expectations
COMMENTS: Becky’s oral and written communication skills are very good. She has a strong ability to
listen, ask good questions, and summarize information. She is a very good public speaker as well.
4. Knowledge and Representation of Organization and Program: For example, adherence to policies
and procedures; accurate understanding and articulation of mission, goals, and structure of
organization; understanding of the organizational environment
Rarely meets expectation Generally meets expectation Occasionally exceeds expectations Frequently exceeds
expectations
COMMENTS: Becky worked on a variety of projects for clients from different organizations. She did a
good job adhering to policies and procedures as well as working to understand and articulate the
mission, goals, and structure of the organization. She also familiarized herself with organizational
environments.
5. Professional Behavior: For example, establishes rapport with clients/educational entities; effective
team member; strong interpersonal communication skills; manages stress; maintains appropriate
affect and professional behavior with clients/educational entities and colleagues; appropriate
problem-solving abilities and mediation skills
Rarely meets expectation Generally meets expectation Occasionally exceeds expectations Frequently exceeds
expectations
COMMENTS: Becky is very good at establishing rapport with clients including educational institutions.
She is a very good team member with exceptional interpersonal skills. While she had a lot of stress
during the term of the internship including a heavy volume of schoolwork, she did her best to handle it.
Her professional behavior was very good, and I only wish I had more time to work with her.