Final Evaluation Form

University of Houston Externship
FINAL EVALUATION FORM
FAX to (713) 743-2926
Attn: Kathy Ermgodts

Supervisor’s Name (printed):______________________ Date: ___________________

Supervisor’s Signature: ______________________ ASHA ID: ___________________

Name of Facility: ______________________ Email: ___________________

Student Name (printed): ______________________ Date: ___________________

Student Signature: ______________________ Final Grade: ___________________

SEMESTER GOALS:

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

4. _______________________________________________________________

5. _______________________________________________________________

Progress toward goals:

Continued focus:

Mid-term Evaluation Form

University of Houston Externship
MID-TERM EVALUATION FORM
FAX to (713) 743-2926
Attn: Kathy Ermgodts

Supervisor’s Name (printed):______________________ Date: ___________________

Supervisor’s Signature: ______________________ ASHA ID: ___________________

Name of Facility: ______________________ Email: ___________________

Student Name (printed): ______________________ Date: ___________________

Student Signature: ______________________ Final Grade: ___________________

SEMESTER GOALS:

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

4. _______________________________________________________________

5. _______________________________________________________________

Progress toward goals:

Continued focus: