Academic Training Evaluation (Exchange Visitor)

Academic Training evaluations are a requirement of the U.S. Department of State.

The student must submit the end-of-program evaluation one week prior to the end of the Academic Training or, if applicable, before an application to extend Academic Training is submitted.

Question 1

Please type your first and last name below.

Student's First Name
Student's Last Name

Question 2

Please provide the information below.

SEVIS ID #:
UCLA ID #:
Date of birth (MM/DD/YYYY):
Phone # (000-000-0000):
Email:
Local U.S. Address:
AT Organization Name
Supervisor's First and Last Name
Supervisor's Email Address

Question 3

How would you rate the effectiveness of your Academic Training in enhancing the objectives and goals of your academic program at UCLA?

Very effective
Effective
Slightly effective
Not effective

Question 4

How well did the Academic Training experience meet your expectations?

Exceeds expectations
Meets expectations
Partially meets expectations
Does not meet expectations

Questions 5 - 10

Please indicate how much you agree or disagree with the following statements.

Because of this Academic Training experience, I gained:

	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
Confidence to navigate a U.S. work environment
Opportunities to share my culture or country with others in the workplace
New skills that will further my career
Professional connections that further my career
Practical experience related to my field of study
New knowledge related to the organization or industry in which I worked

Question 11

What aspects of your Academic Training were the most useful? (Required)

Question 12

Do you have any additional comments you'd like to share about the Academic Training experience?