PROGRAM BOOK FOR
SHORT-TERM INTERNSHIP
(Off - line)
Name of the Student:
Name of the College:
Registration Number:
Period of Internship: From: To:
Name & Address of the Intern Organization:
An Internship Report on
(Title of the Internship)
Submitted in accordance with the requirement for the degree of
Under the Faculty Guideship of
(Name of the Faculty Guide)
Department of
(Name of the Department)
Submitted by:
(Name of the Student)
Reg.No: _____
(Name of the College)
Student’s Declaration
I, a student of
Program, Reg. No. of the Department of
College do hereby declare that I have completed the mandatory internship
from to in (Name of
the intern organization) under the Faculty Guideship of
(Name of the Faculty Guide), Department of
(Name of the College)
(Signature and Date)
Certificate from Intern Organization
This is to certify that _ (Name of the intern)
Reg. No of _ (Name of the
College) underwent internship in (Name of the
Intern Organization) from to
The overall performance of the intern during his/her internship is found to be
_ (Satisfactory/Not Satisfactory).
Authorized Signatory with Date and Seal
EVALUATION
Evaluation by the Supervisor of the Intern Organization
Student Name: Registration No:
Term of Internship: From: To :
Date of Evaluation:
Organization Name & Address:
Name & Address of the Supervisor
with Mobile Number
Please rate the student’s performance in the following areas:
Please note that your evaluation shall be done independent of the Student’s self-
evaluation
Rating Scale: 1 is lowest and 5 is highest rank
1 Oral communication 1 2 3 4 5
2 Written communication 1 2 3 4 5
3 Proactiveness 1 2 3 4 5
4 Interaction ability with community 1 2 3 4 5
5 Positive Attitude 1 2 3 4 5
6 Self-confidence 1 2 3 4 5
7 Ability to learn 1 2 3 4 5
8 Work Plan and organization 1 2 3 4 5
9 Professionalism 1 2 3 4 5
10 Creativity 1 2 3 4 5
11 Quality of work done 1 2 3 4 5
12 Time Management 1 2 3 4 5
13 Understanding the Community 1 2 3 4 5
14 Achievement of Desired Outcomes 1 2 3 4 5
15 OVERALL PERFORMANCE 1 2 3 4 5
Date: Signature of the Supervisor
MARKS STATEMENT
(To be used by the Examiners)
INTERNAL ASSESSMENT STATEMENT
Name Of the Student:
Programme of Study:
Year of Study:
Group:
Register No/H.T. No:
Name of the College:
University:
Sl.No Evaluation Criterion Maximum Marks
Marks Awarded
1. Activity Log 25
2. Internship Evaluation 50
3. Oral Presentation 25
GRAND TOTAL 100
Date: Signature of the Faculty
Guide
Certified by
Date: Signature of the Head of the Department/Principal
Seal: