INTERNSHIP EVALUATION FORM

Madam or Sir,
You have welcomed an intern from the University of Rouen and we thank you for that. In order to evaluate
this training period in a professional context, and in line with the article n12 of the agreement, we would
be grateful if you could fill in the following document and send it back to the students supervisor.

INTERN
Name Surname Date of birth
day / month / year

Degree Year
Tittle of the degree

Supervisor
E-mail

WELCOMING STRUCTURE
Name of the structure
Address

Name of the Supervisor

Position
E-mail

INTERNSHIP
Type of the internship : Mandatory Non Mandatory duration
Specify the number of weeks or months
Object of the internship :

Date : From to
day / month / year day / month / year

Tasks of the intern :

Skills to acquire or develop :

1/3
Direction des Enseignements et du suivi des Parcours tudiants
Bureau dAide lInsertion Professionnelle
24 bis rue Jacques Boutrolle dEstaimbuc - 76821 Mont Saint Aignan cedex
INTERNSHIP EVALUATION

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d
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ate
g
din

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Go
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No
Professionnal integration

Ve

Fa

To
General interest shown for the host structure and positions

Ability to understand the organisation of the host structure

Ability to adapt to work constraints

Ability to respect instructions and hierarchy

Ponctuality

Ability to interact

Precision in work tasks

Organisation skills

Autonomy

Implication and initiative

Professionnal skills

Ability to analyse and contextualize the project or topic

of the internship
Ability to refer/use academic knowledge

Ability to propose improvements, solutions

Ability to summarize

Ability to team work

Oral skills

Writing skills

Remarks

2/3
Direction des Enseignements et du suivi des Parcours tudiants
Bureau dAide lInsertion Professionnelle
24 bis rue Jacques Boutrolle dEstaimbuc 76821 Mont Saint Aignan cedex
GENERAL EVALUATION

Were the objectives met ?

Yes No Partially

If not or partially, please explain :

General evaluation of the intern

Very satisfying Satisfying Fair

Skills to acquire or develop

Remarks and observations

Date : Stamp of the host structure

day / month / year

Name and signature of the supervisor

Name and signature of the intern

3/3
Direction des Enseignements et du suivi des Parcours tudiants
Bureau dAide lInsertion Professionnelle
24 bis rue Jacques Boutrolle dEstaimbuc 76821 Mont Saint Aignan cedex