CPE Internship Site Coordinator Assessment
You are requested to provide an assessment regarding the development of the CPE Intern.
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Today's date
Internship Clinical Site
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Please provide the name of your organization where the student completed their clinical hours.
Internship Site Coordinator
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First Name
Last Name
Internship Site Coordinator Email
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CPE Student
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First Name
Last Name
CPE Student's Email
*
CPE Supervisor-Educator
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First Name
Last Name
CPE Supervisor-Educator Email
*
Rate the CPEI Intern using the scale: 5=Strongly Agree; 4=Agree; 2=Disagree; 1= Strongly Disagree. Feel to add comments, but not necessary.
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Rows
5
4
2
1
CPE student participated in a variety of pastoral care opportunities for growth and development.
CPE student was punctual and dressed in appropriate professional attire.
CPE student followed policies/requirements of the work site.
CPE student was comfortable asking questions regarding work responsibilities.
CPE student was open to feedback from Intern Site Coordinator regarding work responsibilities.
CPE student was beneficial to the work site team.
Internship Site Coordinator directed the CPE student to their CPE Supervisor-Educator for processing cases and guidance on pastoral care skills.
Comments (Feel free to share additional comments).
As the Internship Site Coordinator, I verify the student named above completed the following number of clinical internship hours during this CPE course.
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Please indicate the number of clinical internship hours completed by the student at your site. Students are required to accumulate a combined total of 300 hours across all clinical sites.
Signature: Internship Site Coordinator
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