Intern Feedback Form

Student/ Intern Feedback Form
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Prospective Graduation Date:

MonthDayYear
Date
Department
Name of Supervisor(s)
Overall, how would you rate your experience at Southland?
How would you rate the working relationship with your supervisor(s)?
How well did the job duties you were given match your knowledge and skills?
How comfortable did you feel asking questions throughout your internship?
How interested would you be in pursuing employment at Southland?
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:

Student/ Intern Feedback Form