This form is due at the conclusion of the internship.

Mentor's Name

Date

Student's Name

Term of Internship (ex. Spring '10)

Ministry Placement

Please list the intern's learning goals, rate his or her progress made toward each goal.

Learning Goal 1

Learning Goal 1 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

Learning Goal 2

Learning Goal 2 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

Learning Goal 3

Learning Goal 3 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

Learning Goal 4

Learning Goal 4 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

Learning Goal 5

Learning Goal 5 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

Learning Goal 6

Learning Goal 6 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

Learning Goal 7

Learning Goal 7 Rating

Select One Poor Fair Good Outstanding

Please Elaborate

What are the intern's strengths in ministry?

In what areas (personal or professional) does the student need to work to improve?

What plan of action would you recommend for the intern to improve in these areas?

In what type of ministry do you foresee this student serving in the future?

Additional comments regarding the intern

Location