CUSTOMIZED LEARNING PLAN AND EMPLOYER EVALUATION Circle the Term Student was Registered: Fall
Spring
Summer
Fall
Spring
Summer
2012-10
2012-20
2012-30
2013-10
2013-20
2013-30
DIRECTIONS TO THE STUDENT: Complete this section and Student Section of Major Learning Objectives below. Student’s Name Faculty Name Std Home Phone Std Alternate Phone Employer Name
Faculty Phone/ Faculty Fax No. Intern Job Title
Site Supervisor/ Supervisor Phone One year educational/employment/career goals: 1.
Total Hours Required of Internship
2.
2.
Three-year educational/employment/career goals: 1.
Rating of Job Requirements/Internship Goals Rating Excellent (E) Very Good (VG) Good (G) Fair (F) Poor (P)
DIRECTIONS TO THE EMPLOYER: Please use the scoring system at right to rate the student’s job performance.
Point Value 5 pts 4 pts 3 pts 2 pts 1 pt
How to Determine Always Exceed Job Requirements Sometimes Exceeds Job Requirements Meets Job Requirements Sometimes Meets Job Requirements Rarely Meets Job Requirements
PERFORMANCE RATING (Completed by the Employer) E (5) VG(4) G(3) F(2) P(1)
MAJOR LEARNING OBJECTIVES PROGRAM OBJECTIVES -- (Developed by FIS) 1. 2. 3. 4.
EMPLOYER OBJECTIVES -- (Developed by Employer re: Specific duties assigned to this Student.) 1. 2. 3. 4.
STUDENT OBJECTIVES — (Developed by Student with FIS) 1. 2. 3. 4. Subtotal Score for this Page (5) CLP.v08.11