Practicum Student Evaluation Form Completed by Supervisor

Revised 2/2010

Practicum Student Evaluation Form – Completed by Supervisor

Student: Practicum Site:

Semester: Site Supervisor(s):

TAMU Supervisor: Supervisor(s) Completing the Form: ____Site ____ TAMU

Year in Program: 1st year 2nd year 3rd year 4th year

Date completed: Date reviewed with Student:

Activities the student engaged in during this practicum experience (check all that apply):

Assessment:

_____ Functional Behavioral Assessment _____ Intake for Therapy _____ CBM and Benchmarking in _____ Professional report writing conjunction with RTI _____ Standardized Assessment _____ Assessment feedback to families or (Cognition, Achievement) schools _____ Standardized Assessment _____ Other: ______(Personality, Psychological)

Therapy/Counseling:

_____ Individual Therapy/Counseling _____ Parent training _____ Family Therapy/Counseling _____ Group Therapy/Counseling _____ Supervision of other students _____ Other: ______

Consultation/System-level Intervention

_____ Conjoint Behavioral Consultation _____ System Intervention:______Teacher Consultation _____ Presentation of In-Service _____ Other: ______Revised 2/2010

Please indicate the student’s level of performance in each of these areas based on this practicum experience. Please rate the student’s performance relative to other students at the same developmental level.

 Unsatisfactory (U) indicates the student is deficient in the competency or skill and there needs to be significant further training and a special effort made in order to bring it up to the Successful level.  Needs Improvement (NI) indicates the student has shown some evidence of the competency or skill, but performance is inconsistent or there may be examples of poor motivation or minor irresponsibility. It is anticipated that the rating will improve with some further training, supervision, and student effort.  Successful (S) indicates the student has shown basic mastery of the competency or skill.  No Opportunity should be used if the competency was not required as part of this practicum experience.

Please indicate the degree to which the student exhibits the following behaviors/qualities/skills. If you indicate that a student is as “Unsatisfactory” or “Needs Improvement” on any of these skills, please provide additional detail following each table.

Professional and Ethical Behavior

U NI S No Opportunity Ability to listen and be empathic with others Respect for/interest in others’ cultures, experiences, and values. Ability to take respectful, helpful and professional approaches to working with clients/parents/families/schools Ability to work collaboratively with supervisor and benefit from supervision Ability to take feedback (respond to supervision) constructively and respond appropriately Ability to present oneself in a professional manner Ability to communicate ideas verbally and in written form Adherence to ethical/professional codes, standards, and guidelines Timeliness in completing tasks Attitude toward continued learning, scholarly inquiry, and problem-solving

Please explain any U or NI ratings: ______Revised 2/2010

Assessment and Diagnosis

If assessment and diagnosis were not part of the practicum, please check here and proceed to the next section: ______

U NI S No Opportunity Ability to select appropriate methods of evaluation Ability to accurately administer and score assessment measures Ability to interpret results and develop diagnoses and/or case formulations Ability to generate appropriate recommendations and/or treatment plans Ability to write a clear and comprehensive professional report Ability to provide clear and appropriate feedback

Please explain any U or NI ratings: ______

Therapy or Counseling If therapy or counseling were not part of the practicum, please check here and proceed to the next section: ______

U NI S No Opportunity Ability to translate a case formulation into specific intervention strategies Ability to implement a session plan while maintaining rapport Ability to attend to and address therapy process issues Ability to teach skills clearly and at a developmentally appropriate level Ability to utilize assessment results and other feedback to monitor treatment progress Ability to identify and engage key players (e.g., parents, teachers) in treatment

Please explain any U or NI ratings: ______Revised 2/2010

Consultation or System-level Interventions If consultation or system-level interventions were not part of the practicum, please check here and proceed to the next section: ______

U NI S No Opportunity Understanding of and respect for the organizational structure Interventions/recommendations offered are sensitive to the needs of the population, organization or environment Ability to develop and implement a systematic approach to information gathering in a consultative role Ability to work collaboratively with other professionals to generate an effective intervention plan Ability to monitor and modify intervention in response to continued evaluation or feedback

Please explain any U or NI ratings: ______

General Feedback

Please describe the student’s strengths: ______

Please indicate any areas in need of improvement: ______

Reviewed With Student

Signature of supervisor ______Signature of student ______Date ______