J-1 Student Intern Evaluation Form

“An exchange visitor program sponsor must develop procedures for evaluating all student interns. The program sponsor must conduct such evaluations for each Student Intern. All programs

must do a concluding evaluation, and programs lasting more than six months must do a midpoint and concluding

evaluation. The sponsor must retain these evaluations for at least three

years following the completion of the student's internship program.” [22 C.F.R. § 62.23(i)(5)]

J-1 Student Intern Evaluation Form

To be completed by supervisor and submitted to International Student & Scholar Services:

Name of Intern ______________________________

Intern’s Home University___________________

Dates of Internship ______________________ to ________________________

 Midpoint evaluation (for internships 6 months or longer)

 Concluding evaluation

Overall Evaluation:

 Outstanding  Satisfactory  Unsatisfactory  Incomplete at conclusion date –extension requested

Describe below the student intern’s projects to date at American University (refer to goals in DS-

7002) and assessment of effort and quality of work (if “incomplete,” provide an explanation and proposed

timeline for completion, not exceeding a total length of 12 months):

_____________________________________________________________________________________

 Continues on other side (if additional space needed) →

I certify that the above is an accurate evaluation of the student intern:

Name & title of internship supervisor: _______________________________________________________

Signature: ______________________________________________________

Date: ______________

INTERN:

I acknowledge receipt of this evaluation form:

Name: _________________________ Signature: ____________________ Date: _____ AU ID#:_______

International Student and Scholar Services · Butler Pavilion 410 · 4400 Massachusetts Ave., NW · Washington, DC 20016 · USA

Phone: +1-202-885-3350 · Fax: +1-202-885-3354 · E-mail: J1EV@american.edu ·

K:ISSSJ-1PROGJ-1 FormsStudent Intern Evaluation Form 2015.docx