Evaluation Form for Clinical Interpretation Internship

Copy and give to your hospital, clinic, or trip supervisor

Name of Student:
Rice ID:
Name of institution or program:
Name of Supervisor (must be an impartial third party):	____________________		______________________ Signature
Date of Internship:	____ /____ / ____    to ____ /____  /____   Hours completed: __40   __80   __120
Please Comment
Attendance:
Professionalism (Attire, Behavior, Observance of Rules and Regulations, etc.)
Interpersonal Skills (with Physicians, Staff, Patients, Family Members)
Overall Performance:
Grade (please grant A+ only to students who have done work beyond what is expected):	__A+    __A __A-	__B+ __B __B-		__C+ __C __C-	__D+ __D __D- __F
Date:	____ /____ / ____

Thank you for giving this opportunity to our student.

Please return the completed form to the student or fax it to

Veronica Albin at 713-666-9117