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EUID:

Classification:

Experiential Learning activity:

Organization or Company of your placement:

Hours you actually completed:

0
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100
150
200
250
300
350
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500

Hours Completed at Site Placement

Was this a paid opportunity?

Yes
No

I have gained capabilities in the following areas:

I have gained capabilities in the following areas:
	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Acquired job- or work-related knowledge and skills	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Solved complex real-world problems	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Developed or clarifying a personal code or values and ethics	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Critical thinking and analysis of arguments and information	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Creative thinking and problem solving	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Research skills	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Evaluated multiple approaches to a problem	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Invented new methods to arrive at unconventional solutions	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Generated new ideas	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Networking and relationship building	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Leadership skills	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Technological skills	Strongly Disagree	Disagree	Somewhat Disagree	Neither Disagree nor Agree	Somewhat Agree	Agree	Strongly Agree	Non Applicable

How likely do you agree with the following statements?

This experiential learning activity...

How likely do you agree with the following statements?
This experiential learning activity...
	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Was effortful where you devoted considerable time and effort to purposeful tasks.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Required you to make daily decisions that deepened your investment in the activity and your commitment to your academic program and college.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Helped build substantive relationships. You developed a meaningful relationship with another person (faculty or staff member, student, coworker, or supervisor).	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Put you in the company of mentors and advisers as well as peers who share intellectual interests and are committed to seeing that you succeed.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Helped you engage across differences. You experienced diversity through contact with people who are different from you and you were challenged to develop new ways of thinking about and responding immediately to novel circumstances on intellectual and practical tasks, inside and outside the classroom, on and off campus.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Provided you with rich feedback from your supervisor. You were offered frequent formal and informal feedback about your performance.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Helped you apply and test what you were learning in new situations. You were provided opportunities to see how what you are learning works in different settings, on and off campus.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Provided opportunities for you to reflect on the person you are becoming.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Helped you develop the ability to take the measure of events and actions and put them in perspective.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable
Helped you to now better understand yourself in relation to others and the larger world, and you have acquired the intellectual tools and ethical grounding to act with confidence for the betterment of the human condition.	Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree	Non Applicable