ICLS Evaluation Form: Intern/Trainee

Today's Date*

Date

Are you an Intern or a Trainee? If you are unsure, look at your DS-7002 or DS-2019 under "Program Category" or "Exchange Visitor Category."*

InternTrainee

Your Name*

First NameLast Name

Host Organization Name*

Please write the name of your host company.

Is this a midpoint evaluation or a final evaluation? *

MidpointFinal

Have YOU moved recently? If yes, please enter your new address. If no, you may skip this.

Street Address

Room or Apartment Number

CityState / Province

Postal / Zip Code

Has your HOST moved recently? If yes, please enter their new address. If no, you may skip this.

Street Address

Room or Apartment Number

CityState / Province

Postal / Zip Code

Please Select as Appropriate*

	Yes	Usually	No
I am following my DS-7002 Training Plan
I have a good environment for training
I am getting adequate support from my colleagues and supervisors
I interact with my American colleagues
If I have concerns or problems, I'm comfortable speaking with my host supervisor
I feel safe at my host
When I communicate at work, it is in English

If you answered "No" to any of the above statements, please explain:

Please Select as Appropriate: *

	Yes	Usually	No
I have adjusted well to daily life in the U.S.
I am able to get around the city, go shopping, use banks, etc.
I feel safe at my housing

If you answered "No" to any of the above, please explain:

If there is anything you'd like to discuss or mention, please write it below.

Please describe the cultural activities you have taken part in either outside of your host organization or with your host organization.*

Upload at least ONE Picture of a Cultural Experience

Picture of Cultural Experience

Please provide a picture (or multiple) that show your cultural experience in the U.S.

If you have reached out to ICLS, how helpful were they in assisting you with any questions or concerns?*

Very helpfulA little helpfulNot helpfulI have not contacted ICLS with questions or concerns

I the undersigned certify that the information contained in this evaluation report is true to the best of my knowledge.

Further, I hereby grant the International Center for Language Studies permission to use my image in photographs in any and all of its publications, including but not limited to all of the International Center for Language Studies' printed and digital publications. I understand and agree that any photograph using my likeness will become property of the International Center for Language Studies and will not be returned.

I acknowledge that since my participation with the International Center for Language Studies is volunary, I will receive no financial compensation.

I authorize the International Center for Language Studies to edit, alter, copy, exhibit, publish, or distribute any photograph which includes my image for purposes of publicizing the International Center for Language Studies' programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including any written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising out of, or related to, the use of the photograph.

I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Signature*

INTERN & TRAINEE EVALUATION

Host Company Information

Life in the US

Certification & Photo Release