This instrument serves as both the summative evaluation of the intern and the clinical
educator's letter of reference. It should provide a clear assessment of the intern's
level of performance for each of the folllowing indicators using the following rubric,
bearing in mind that most interns will perform at the basic and proficient levels;
the distinguished level should be reserved for performance that is above and beyond
the basic requirements of the internship.
Distinguished: The intern has demonstrated an exemplary ability
to model the identified indicator in the classroom setting.
Proficient: The intern is able to demonstrate the identified performance
indicator on a consistent and effective basis.
Basic: The intern is able to demonstrate the identified performace
indicator well enough to meet minimal expectations.
Unsatisfactory: The intern is unable to demonstrate the identified
Please refrain from submitting your form more than once in a session. If you are unsure if your form was submitted, contact Rhonda Wolff at email@example.com for verification.
Black Hills State University, 1200 University St., Spearfish, SD 57799, (800) 255-2478 | © 2014
Monday, January 26, 2015