Intern Name: ___________________________________
Date: _____________________________________________
Evaluator: _______________________________________
Does the intern meet the Yes No Needs Comments
following expectations? improvement
1. Was the client properly
greeted?
2. Was the agency’s mission
and purpose clearly
explained to the client?
3. Was the agency’s
LifeWorks! Employment
Readiness Program clearly
explained?
4. Was the agency’s “Working
Smart” program clearly
explained?
5. Was the agency’s “Seeking
Safety” program clearly
explained?
6. Was the intake form
clearly explained and
completed?
7. Was the services
agreement clearly explained
and completed?
8. Was the consent of release
clearly explained and
completed?