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Program Evaluation Form

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J-1 Scholar

Program Evaluation Form

Division of Global Affairs, Education Abroad Office

To be completed by supervisor

J-1 scholars must make normal progress in their exchange program and complete all J-1 activities by

the end date on their Forms DS-2019. This form is designed to assist you in discussing and

evaluating a J-1 scholar’s program activities.

Please meet with your J-1 scholar to discuss their progress before completing this form. Email a

signed copy of this form to

mmiller@kennesaw.edu

within 10 business days after receiving an email

reminder.

NOTE: Departments should report any changes in a scholar’s J-1 program to DGA immediately for

review and approval.

period: ____________________ (mm/dd/yyyy) to ____________________ (mm/dd/yyyy)

_____________________________________________________________________________

Evaluation

____________________________________________________________________________

Name of J-1 scholar:

____________________ (mm/dd/yyyy)

J-1 site(s) of activity:

Excellent

Good

Poor

Expected program end date:

If poor, describe improvement plans:

Overall rating:

Yes

Possesses English language proficiency to conduct J-1 activities.

Check as applicable to the J-1 scholar:

Yes

Is making progress toward a timely, satisfactory completion of the J-1 program.

Yes

Has been participating in cultural activities as required by the J-1 federal regulations

List cultural activities:

Supervisor’s name: ________________________________________________________________________________

Title: _____________________________________ Department: _______________________________________

Email: ____________________________________ Phone: ____________________________________________

Signature: _________________________________ Date: _____________________________________________

Program Evaluation Form

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