Intern Feedback Form

Student/ Intern Feedback Form
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Prospective Graduation Date:

Month Day Year
Date
Department
Name of Supervisor(s)
Overall, how would you rate your experience at Southland?

Excellent Very good Good Fair Poor
How would you rate the working relationship with your supervisor(s)?

Excellent Very good Good Fair Poor
How well did the job duties you were given match your knowledge and skills?

Extremely well Very well Somewhat well Not so well Not at all well
How comfortable did you feel asking questions throughout your internship?

Extremely comfortable Somewhat comfortable Not at all comfortable
How interested would you be in pursuing employment at Southland?

Extremely interested Somewhat interested Not at all interested
How much did you learn from your time at Southland?

1

2

3

4

5

1 is I didn't learn anything new, 5 is I learned more than expected
How likely it is that you would recommend a friend/ colleague to intern with us?

1

2

3

4

5

1 is Not Likely, 5 is Extremely Likely
Anything you would like to share about your experience?
What suggestions could you offer to better our clinic?
(In your experience, what did Southland do well and what could we improve?)
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Student/ Intern Feedback Form