ICEO - WAT Final Evaluation

Final Evaluation


Participant Information

Social Security#

Last Name:

First Name:		Middle Initial:

DS-2019 #:

Date of Birth (mm/dd/yyyy):

U.S. Address :	(do not enter the address of your employer)

City:

State:		Zip:

Participant's phone number:

Email


Employer Information

Employer:

Employer Address:

City:

State:		Zip:

Supervisor's Name:

Supervisor's Phone: (555-555-5555)


Employment

Start date of employment in the US (mm/dd/yyyy)

Month for report: (mm/dd/yyyy)

Please rate the following, thus far in your program, on a scale of 1-4 (1 - poor, 2 - average, 3 - good, 4 - excellent and 5 - not applicable)

Your cooperation with your employer: 1 2 3 4 Your Employment location: 1 2 3 4 Your job: 1 2 3 4 Your relationship with other ICEO participants: 1 2 3 4

Approximately, how many hours per week did you work last month?

Are you satisfied with your job? YES NO

What is your current position? f you aren’t satisfied with your job, what would you change about it? Please list the cultural activities you have participated in during this month Comments:





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By clicking here, I confirm I am the person above and have completed this form to the best of my ability

Thank you for helping us in improving the program for you and your fellow students ! We look forward to seeing you again.




	WAT Program Definition

	Social Security & Taxes

	Eligible and Ineligible Jobs

	Travel Options


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