| |
Circle the appropriate rating |
| 1. |
Consultation - System Level
|
|
|
|
|
|
|
| 1a. |
Is able to serve as a system level consultant by offering pertinent in-service workshops to school personnel.
|
5 |
4 |
3 |
2 |
1 |
0 |
| 1b. |
Is able to participate in system (building or district) level consultation (needs assessment, strategic planning, curriculum planning, program evaluation, etc.)
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 1c. |
Is able to effectively lead team efforts involving parents, teachers and other relevant helping professionals to implement school based intervention programs.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 2. |
Individual Psychoeducational Studies
|
|
|
|
|
|
|
| |
Is able to conduct assessment by using some but not necessarily all, of these procedures: review of historical data, interviews, observation, sensitivity to relevant environmental variables, and formal and informal tests.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 3. |
Dissemination of Information
|
|
|
|
|
|
|
| 3a. |
Is able to interpret and share, with parents, teachers, and other appropriate school personnel, information from psycho-educational assessment in a meaningful manner.
|
5 |
4 |
3 |
2 |
1 |
0 |
| 3b. |
Is able to interpret and share, with parents, teachers, and other appropriate school personnel, information from psycho-educational assessment in a meaningful manner.
|
5 |
4 |
3 |
2 |
1 |
0 |
| 3c. |
Provides adequate follow up.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 4. |
Intervention
|
|
|
|
|
|
|
| 4a. |
Special Education: Is able to plan interventions based on assessment data collected in investigating school-related problems.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 4b. |
Regular Education: Is able to make appropriate recommendations for improvement of all learners' skills to include affective and social skills and providing effective mental health education.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 5. |
Counseling
|
|
|
|
|
|
|
| |
Knows when counseling is appropriate; has skill in utilizing counseling techniques and provides a counseling service consistent with the level of prior training; knows when to terminate counseling relationship.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 6. |
Uses knowledge of professional roles and responsibilities expected of a school psychologist.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 7. |
Conducts self in accordance with professional ethics.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 8. |
Uses knowledge of legal mandates/issues relevant to professional role.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 9. |
Displays skills needed to interpret assessment data upon which to base judgments in order to make decisions regarding school related problems.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 10. |
Displays awareness/knowledge as to the organization and operations of schools.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 11. |
Is able to choose and implement (directly or indirectly) appropriate behavior intervention strategies.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 12. |
Displays sensitivity and is able to adapt consultation, assessment, intervention, etc. to meet the needs of those challenged by cultural diversity and/or disabilities.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 13. |
Is able to conduct comprehensive social and personality assessment.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 14. |
Liaison Agent
|
|
|
|
|
|
|
| 14a. |
Is able to assess professional interactions within the educational system as well as the broader helping professional delivery systems of the community, develop strategies for becoming an effective part of those systems, and work in those systems effectively to promote better understanding of child learning and development and to enhance service to children.
|
5 |
4 |
3 |
2 |
1 |
0 |
| 14b. |
Serves as a liaison for the school and community services; had knowledge of resources, policies, and procedures for referral.
|
5 |
4 |
3 |
2 |
1 |
0 |
| 14c. |
Demonstrates professional judgment as to when and where the referral should be made and provides necessary follow-up for all referrals.
STRENGTHS:
WEAKNESSES:
|
5 |
4 |
3 |
2 |
1 |
0 |
| 15. |
Research
|
|
|
|
|
|
|
| |
Demonstrates skills in designing, conducting, and evaluating applied research (check all that apply):
_____ N = 1 Case Study Evaluation
_____ Program Evaluation
_____ Empirical Study
_____ Evaluation of efficacy of school psychological service delivery
STRENGTHS:
WEAKNESSES:
|
| 16. |
Current summary of internship hours:
- Number of hours logged under Regular Education: _____
Percentage of total hours that this represents: _____
- Number of hours logged under Special Education: _____
Percentage of total hours that this represents: _____
- Number of hours logged under supervision: _____
|
| 17. |
How would you rate this student in terms of overall effectiveness?
- Very effective
- Moderately effective
- Not very effective
- Counter-productive
|
| 18. |
Please indicate the source for the information used to complete this evaluation. Explain each choice and utilize feedback form as many sources as possible.
- Feedback from school personnel
- Feedback from children
- Feedback from parents
- Direct observation of the student at work
- Review of written work of student
- Other
|
| 19. |
Please circle your recommendations for the internship student and explain each:
- Additional coursework needed
- Additional field work needed
- Should be recommended for certification
- Other
|