Practicum Evaluation

2/06 PRACTICUM EVALUATION SITE SUPERVISOR

Counselor-in-Training’s Name ______

Site Supervisor ______

Site ______

Date ______

Please evaluate the counselor-in-training on each of the characteristics listed below. Place an X in the space provided which best describes the trainee’s performance relative to the item.

The counselor-in-training demonstrates: Unsatis- Not Very Good Good Average factory Applicable

Promptness ( ) ( ) ( ) ( ) ( ) Dependability ( ) ( ) ( ) ( ) ( )

Prior preparation for sessions with clients ( ) ( ) ( ) ( ) ( )

Cooperativeness ( ) ( ) ( ) ( ) ( )

Openness to feedback ( ) ( ) ( ) ( ) ( )

Follow through with tasks ( ) ( ) ( ) ( ) ( )

Initiative ( ) ( ) ( ) ( ) ( )

Independence in the performance of tasks ( ) ( ) ( ) ( ) ( )

Flexibility ( ) ( ) ( ) ( ) ( )

Tolerance for ambiguity ( ) ( ) ( ) ( ) ( )

Self-control ( ) ( ) ( ) ( ) ( )

Self-confidence ( ) ( ) ( ) ( ) ( )

Clear and effective ( ) ( ) ( ) ( ) ( ) communication 2/06 Tactfulness ( ) ( ) ( ) ( ) ( ) Unsatis- Not Very Good Good Average factory Applicable

Respect for clients ( ) ( ) ( ) ( ) ( )

Ability to understand clients’ points of views ( ) ( ) ( ) ( ) ( )

Skill in securing cooperation of clients in individual counseling ( ) ( ) ( ) ( ) ( )

Skill in securing cooperation of clients in group work ( ) ( ) ( ) ( ) ( )

Maintenance of confidentiality ( ) ( ) ( ) ( ) ( )

Adherence to ethical standards ( ) ( ) ( ) ( ) ( )

Skill in relating to diverse types of clients ( ) ( ) ( ) ( ) ( )

Respect for the power of counseling and an awareness of its limits ( ) ( ) ( ) ( ) ( )

Ability to use/develop appropriate materials or activities for individual or group work ( ) ( ) ( ) ( ) ( )

Identification of self as a counselor in the setting ( ) ( ) ( ) ( ) ( )

Ability to function as a team member ( ) ( ) ( ) ( ) ( )

Productive interaction with other personnel in the setting ( ) ( ) ( ) ( ) ( )

Knowledge of “in-house” resources and referral sources ( ) ( ) ( ) ( ) ( )

Knowledge of community resources and referral sources ( ) ( ) ( ) ( ) ( ) 2/06

Please summarize what you consider to be the strengths of this counselor-in-training and provide specific examples when possible.

Please summarize areas for improvement or refinement that you can recommend for the continuing professional development of this counselor-in-training.

Please share any additional comments.

If you want to comment on the specific counseling skills of the counselor-in-training, please respond on the attached form. Thank you for your assistance and work with this trainee.

______Site Supervisor’s Signature 2/06