2015 Regina Gottlieb Scholarship Evaluation Form

Please rate the dietetic intern who has been under your supervision on the following qualities. A point system will be used to rate each quality. Rating codes are:

5: Outstanding

4: More than satisfactory

3: Satisfactory

2: Needs improvement

1: Unsatisfactory

(Required)
(Required)
(Required)
Factors to consider: clarity of written assignments, ability to plan the day's schedule and priorities and work within a time frame, clarity of communication.
  5 4 3 2 1
Work Organization
(Required)
Factors to consider: self-starter, seeks additional responsibilities, works with minimal supervision
  5 4 3 2 1
Initiative
(Required)
Factors to consider: works independently, punctuality, conforms to established standards.
  5 4 3 2 1
Responsibility
(Required)
Factors to consider: reaction to changes which disrupt routine, adapts to new situations, unusual demands, sudden changes and/or emergencies, reaction to increase in work load or assignments.
  5 4 3 2 1
Adapatability
(Required)
Factors to consider: interpersonal skills, attitude towards supervision and/or instructions received, professionalism, and communications
  5 4 3 2 1
Teamwork
  5 4 3 2 1
Career Potential
(Required)
Contact Us

Program Director

Angie Hasemann, MS, RDN, CSP

ajh5j@virginia.edu

434-924-2348

 

Assistant Program Director

Dana Cullen, RD

dnc4s@virginia.edu

434-982-4925