Fillable J-1 Student Intern Evaluation Form printable pdf download

J-1 Student Intern Evaluation Form

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J-1 STUDENT INTERN EVALUATION FORM

Purpose: J‐1 Student Interns are required by federal immigration regulations to submit evaluations to the HIO to outline whether program objectives

are being met. Students should coordinate with their internship supervisors to complete and sign the evaluation form.

For internships lasting less than six months in duration, only one evaluation is required, a Final Evaluation submitted before the student departs the

U.S. For internships lasting more than six months in duration, a Mid- Point Evaluation is also required no more than 15 days from the mid‐point of the

internship as reflected on the DS‐7002. Evaluations should be submitted to the HIO via email at

internationaloffice@harvard.edu

with subject line: J-1

Evaluation or fax at 617‐495‐4088. Note that this form is used for both the Mid‐Point Evaluation and the Final Evaluation.

A. Student Intern - Personal Information

Surname:

Given Name:

Date of Birth (MM/DD/YYYY):

B. Evaluation Type – Check ONE

Midpoint Evaluation

Final Evaluation

C. Supervisor Certification - This section must be completed by the internship supervisor: