J-1 Intern/Trainee Midterm Evaluation Form

* All fields are mandatory. Please make sure you fill out all fields before submitting the form, thanks!

Participant Name

Participant AAG ID Number

Participant DS-2019 Number

Name of Host Company

Name of Supervisor

Q1: What skills/knowledge do you think you have gained since the beginning of your program?

Q2: What skills/knowledge would you like to gain for the rest of your program?

Q3: What do you consider to be the most beneficial aspects of your experience in the United States, so far?

Q4: What do you consider to be the most challenging aspects of your experience in the United States, so far?

Q5: Are you on track with the Training plan phases? Yes No

Q6: If not, which phase(s) was not completed yet?

Q7: What cultural activity(s)/opportunity(s) have you experienced during the first semester?

Q8: Have you recently changed of home address? If so, please write your new address information below:

The electronic signatures below indicate that the Intern/Trainee and Host Company representative have completed this evaluation together and agree to all points.

Participant's Name

Signature

Supervisor's Name

Signature

Date