Student/ Intern Feedback Form
Please enter a valid phone number.
Prospective Graduation Date:
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?
Not so well
Not at all well
How comfortable did you feel asking questions throughout your internship?
Not at all comfortable
How interested would you be in pursuing employment at Southland?
Not at all interested
How much did you learn from your time at Southland?
I didn't learn anything new
I learned more than expected
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 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?)
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