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 conjunction with RTI / _____ / Professional report writing
_____ / Standardized Assessment (Cognition, Achievement) / _____ / Assessment feedback to families or schools
_____ / Standardized Assessment (Personality, Psychological) / _____ / Other: ______

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: ______

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: ______

______

______

______

______

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: ______

______

______

______

______

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 ______