Agency Preceptor's Final Evaluation of Intern and Internship Program

1. Thank you for completing this evaluation. SECTION I asks that you evaluate the student intern while SECTION II asks that you evaluate the NYU CPH Internship Program.

SECTION I: FINAL EVALUATION OF INTERN BY AGENCY PRECEPTOR

Contact information:

Name of intern Required Question

Name of agency Required Question

Agency Address

Agency Preceptor Required Question

Address

Semester

Internship start date: Required Question

Internship end date: Required Question

Email Address Required Question

Phone Number Required Question

2. How often and under what circumstances did you directly observe this intern? Required Question

3. Please describe observed professional STRENGTHS demonstrated by the intern during the internship. Required Question

4. Please describe observed professional WEAKNESSES demonstrated by the intern during the internship. Required Question

5. Please rate the intern on the following professional characteristics. Rating range from 1 (Poor) to 5 (Excellent/Excels in this area). Required Question

	1 (poor)	2	3 (average)	4	5 (excellent)
Overall public health knowledge
Acquisition of new information
Application of professional skills
Initiative
Communication skills (overall)
Verbal communication
Written communication
Maturity
Personal relations
Dependability

6. The following is a list of core competencies for public health professionals . Please rate the student intern's skill level. Be candid in your evaluation as the student's competence is a very important measure of readiness for practice.

Rating Scale: * N/A (not applicable) * Not Aware At All * Aware * Knowledgeable * Proficient *

ANALYTIC ASSESSMENT SKILLS: Required Question

	N/A	Not aware	Aware	Knowlegable	Proficient
Defines a problem
Identifies relevant and appropriate data and information sources
Applies ethical principles to collection, use, and dissemination of information
Determines appropriate uses of quantitative and qualitative data

POLICY DEVELOPMENT/PROGRAM PLANNING SKILLS:
Required Question

	N/A	Not aware	Aware	Knowledgeable	Proficient
Collects, summarizes and interprets information relevant to an issue
Translates policy into organizational plans, structures and programs
Develops mechanisms to monitor and evaluate programs for their effectiveness and quality

COMMUNICATION SKILLS Required Question

	N/A	Not aware	Aware	Knowlegable	Proficient
Communicates effectively both in writing and orally, or in other ways
Solicits input from individuals and organizations
Effectively presents demographic, statistical, programmatic, and scientific information for professional and lay audience
Listens to others in an unbiased manner, respects points of view of others

CULTURAL COMPETENCY SKILLS: Required Question

	N/A	Not aware	Aware	Knowledgeable	Proficient
Utilizes appropriate methods for interacting sensitively, effectively and professionally with diverse populations
Identifies the role of cultural, social and behavioral factors in determining the delivery of public health services
Develops and adapts approaches to problems that take into account cultural differences

COMMUNITY DIMENSIONS OF PRACTICE SKILLS: Required Question

	N/A	Not aware	Aware	Knowledgeable	Proficient
Utilizes leadership, team building, negotiation, and conflict resolution skills to build community partnerships
Identifies how public and private organizations operate within a community
Describes the role of government in the delivery of community health services

BASIC PUBLIC HEALTH SCIENCES SKILLS: Required Question

	N/A	Not aware	Aware	Knowledgeable	Proficient
Defines, assesses, and understands the health status of populations, factors contributing to health promotion and disease prevention and factors influencing the use of health services
Applies basic public health sciences (behavioral and social, biostatistics, epidemiology, environmental health, and prevention of chronic and infectious diseases)
Identifies and retrieves current relevant scientific evidence and identifies the limitations of research

FINANCIAL PLANNING AND MANAGEMENT SKILLS: Required Question

	N/A	Not aware	Aware	Knowledgeable	Proficient
Monitors program performance
Applies basic human relations skills to the management of organizations, motivation of personnel and resolution of conflicts

LEADERSHIP AND SYSTEMS THINKING SKILLS: Required Question

	N/A	Not aware	Aware	Knowledgeable	Proficient
Creates a culture of ethical standards within organizations and communities
Promotes team and organizational learning
Contributes to development, implementation, and monitoring of organizational performance standards

7. If you feel that this student demonstrated either markedly superior or very inferior
performance on any of the above traits (or any other variables you might wish to discuss), please elaborate in the space below: Required Question

8. Additional comments:

9. Please rate the NYU Internship Program in Community Public Health. Required Question

	Excellent	Good	Fair	Poor
Preparation of Intern
Supervision of Intern
Internship Guidelines
Liaison with the University

10. EVALUATION OF INTERNSHIP PROGRAM BY AGENCY PRECEPTOR.

Please provide additional comments or how we can better prepare our students for an internship. Required Question

11. Specific suggestions on how we can better strengthen our internship program. Required Question

12. By clicking on the 'submit' button you are affirming that the information you have provided is true and correct.

Please type your name in the box below. Required Question