Guidelines for MPH Programs in Canada

Appendix 7: Interim Evaluation Form

There are two basic questions at the mid-point of the practicum: how have things progressed, and is there a need to adjust the planned objectives, activities and deliverables? The following is an example of an interim evaluation form used at a U.S. school of public health. (See reference document 7).

Please complete this document to describe and explain any changes in the goals, activities, or schedules of the Practicum and to describe how the Practicum has progressed to date. This form must be signed by all parties in order for the student to receive their grade at the end of the semester.

• Student’s Name: 
• Practicum Site: 
• Field-based practicum supervisor: 
• Sponsoring University-based practicum supervisor: 

Describe and explain any changes in the goals, activities or schedules of the Practicum.

Describe how the Practicum has progressed to date, including any problems not mentioned above.

• Student:   Date 
• Faculty Advisor:   Date 
• Field Dite Preceptor:   Date