Graduate Program Assessment:
MSEd and Specialist
Site Supervisor Evaluation of Student Intern
Student Intern Evaluation
To be Completed by Site Supervisor
The following questionnaires were developed to collect evaluative feedback on a number of dimensions. If any particular item is NOT APPLICABLE for a particular intern or NOT PROVIDED by the field placement site, it should be marked "Not Applicable" (N/A).
This form will be kept in the student's folder, accessible to the student and CSP Department Faculty. Anyone else wishing access will need written permission from the student involved.
Thank you for your support of our internship program.
Department of Counseling and School Psychology
University of Nebraska at Kearney
Site Supervisor Evaluation of Field Placement Student
Student:___________________________________ Date:_______________________
Supervisor:________________________________
Site Address:_______________________________ Phone:______________________
City:_________________________________ State:___________ Zip:_____________
The Student Demonstrated:
| 1. |
Sensitivity to his/her impact on others.
very poor 1 2 3 4 5 6 7 excellent
|
| 2. |
Ability to listen to others.
very poor 1 2 3 4 5 6 7 excellent
|
| 3. |
Adequate assertiveness when appropriate.
very poor 1 2 3 4 5 6 7 excellent
|
| 4. |
Ability to learn from mistakes.
very poor 1 2 3 4 5 6 7 excellent
|
| 5. |
Knowledge of his/her own limits.
very poor 1 2 3 4 5 6 7 excellent
|
| 6. |
Ability to be non-defensive and open in the supervisor relationships.
very poor 1 2 3 4 5 6 7 excellent
|
| 7. |
Ability to work cooperatively with peers.
very poor 1 2 3 4 5 6 7 excellent
|
| 8. |
A commitment to professional ethics.
very poor 1 2 3 4 5 6 7 excellent
|
| 9. |
Demonstrated confidence, skill, poise, and tact in dealing with others.
very poor 1 2 3 4 5 6 7 excellent
|
| 10. |
Leadership ability.
very poor 1 2 3 4 5 6 7 excellent
|
| 11. |
Enthusiasm and eagerness to learn and grow.
very poor 1 2 3 4 5 6 7 excellent
|
| 12. |
Promptness in keeping time commitments and appointments, and following through on professional commitments.
very poor 1 2 3 4 5 6 7 excellent
|
| 13. |
Self-motivation and conscientiousness in carrying out tasks and assignments.
very poor 1 2 3 4 5 6 7 excellent
|
| 14. |
A willingness to do more than the minimal requirements.
very poor 1 2 3 4 5 6 7 excellent
|
| 15. |
Ability to write clear, concise, and useful notes about client progress.
very poor 1 2 3 4 5 6 7 excellent
|
| 16. |
Ability to contribute effectively in case conferences.
very poor 1 2 3 4 5 6 7 excellent
|
| 17. |
Ability to fairly quickly develop rapport with new clients and to build strong, trusting.
very poor 1 2 3 4 5 6 7 excellent
|
| 18. |
Ability to develop and implement appropriate long-range therapeutic plans for clients.
very poor 1 2 3 4 5 6 7 excellent
|
| 19. |
Ability to develop appropriate short-term therapeutic plans and goals for each session.
very poor 1 2 3 4 5 6 7 excellent
|
| 20. |
Ability to terminate therapy in a skillful manner.
very poor 1 2 3 4 5 6 7 excellent
|
| 21. |
Ability to allow the client to make his/her own choices and decisions.
very poor 1 2 3 4 5 6 7 excellent
|
| 22. |
Ability to remain focused and not get sidetracked with irrelevant content during therapy.
very poor 1 2 3 4 5 6 7 excellent
|
| 23. |
Ability to adapt his/her approach to the needs of a particular client.
very poor 1 2 3 4 5 6 7 excellent
|
| 24. |
Ability to appropriately handle his/her emotions.
very poor 1 2 3 4 5 6 7 excellent
|
| 25. |
Ability to avoid manipulation of clients.
very poor 1 2 3 4 5 6 7 excellent
|
Comments related to low ratings:
Please objectively describe behaviors which support ratings of 1 or 2 on the foregoing items. List the item number followed by the description. (Please use an additional sheet of paper and attach to this evaluation if more space is required.)
Supervisor's Signature: _____________________________________ Date: ____________