Student Intern Evaluation of Site Supervisor

Department of Counseling &

Educational Psychology

STUDENT INTERN EVALUATION OF SITE SUPERVISOR

COURSE INFORMATION
INSTRUCTOR:
COURSE: SEMESTER:
STUDENT
NAME: BANNER ID #
ADDRESS:
CELL PHONE #: EMAIL ADDRESS:
SITE
NAME OF AGENCY:
ADDRESS:
TELEPHONE PHONE #: WEBSITE:
SITE SUPERVISOR
NAME: DEGREE/CREDENTIALS:
TITLE: LICENSE:
CONTACT PHONE #: EMAIL ADDRESS:

This evaluation is intended to provide feedback regarding the student’s practicum or internship site supervisor. Rate your practicum/internship site supervisor on all applicable items based on your experiences and observations. Please utilize the following key: 1= “not satisfactory”; 2= “below average/minimally satisfactory”; 3= “average/satisfactory”, 4= “above average”, 5= “exceptional”.

1. / Supervisor assisted me in recognizing the impact that diversity and multicultural issues can have on the counseling relationship. / N/A 1 2 3 4 5
2. / Supervisor helped me better understand the impact of social, cultural, and political forces that may affect the lives of my clients. / N/A 1 2 3 4 5
3. / Supervisor helped me identify appropriate interventions to utilize with diverse clients. / N/A 1 2 3 4 5
4. / Supervisor modeled and helped me maintain ethical behavior as outlined by the American Counseling Association. / N/A 1 2 3 4 5
5. / Supervisor was punctual and prepared for my supervision sessions. / N/A 1 2 3 4 5
6. / Supervisor was available for consultation during times outside of regularly scheduled supervision. / N/A 1 2 3 4 5
7. / Supervisor dedicated sufficient time and energy to observing videotapes of sessions, tape processing, and conceptualization of cases. / N/A 1 2 3 4 5
8. / Supervisor made good use of our supervision time. / N/A 1 2 3 4 5
9. / Supervisor offered resource information when I requested it. / N/A 1 2 3 4 5

Revised 07/10/16 2

10. / Supervisor monitored all case materials and client’s progress on a weekly basis. / N/A 1 2 3 4 5
11. / Supervisor was knowledgeable about the site in which I worked and shared that information with me. / N/A 1 2 3 4 5
12. / Supervisor demonstrated expertise with a wide range of client problems and knowledge of a variety of theoretical approaches and therapeutic interventions. / N/A 1 2 3 4 5
13. / Supervisor maintained confidentiality pertaining to information discussed during supervisory sessions. / N/A 1 2 3 4 5
14. / Supervisor provided a supportive environment for me to discuss any challenges or triumphs. / N/A 1 2 3 4 5
15. / Supervisor encouraged me to be reflective and helped me develop increased skill in critiquing and gaining insight from my counseling tapes, case conceptualizations, and/or counseling sessions. / N/A 1 2 3 4 5
16. / Supervisor provided me with constructive feedback related to my areas of growth. / N/A 1 2 3 4 5
17. / Supervisor assisted me in identifying my areas of strength. / N/A 1 2 3 4 5
18 / Supervisor provided me with useful feedback when I did something well. / N/A 1 2 3 4 5
19. / Supervisor gave me useful feedback when I did something wrong. / N/A 1 2 3 4 5
20. / Supervisor gave me appropriate feedback related to intake. / N/A 1 2 3 4 5
21. / Supervisor gave me appropriate feedback related to diagnosis and treatment planning. / N/A 1 2 3 4 5
22. / Supervisor provided me with appropriate feedback related to assessment and goal setting. / N/A 1 2 3 4 5
23. / Supervisor encouraged me to utilize different techniques and interventions when appropriate. / N/A 1 2 3 4 5
24. / Supervisor helped me identify concrete goals for myself during the practicum/internship experience. / N/A 1 2 3 4 5
25. / Supervisor assisted me in identifying the impact that I have on the counseling process. / N/A 1 2 3 4 5
26. / Supervisor provided me the freedom to develop my own counseling style. / N/A 1 2 3 4 5
27. / Supervisor encouraged me and helped me learn about additional counseling theories, interventions, or strategies. / N/A 1 2 3 4 5
28. / Supervisor made me feel like he/she accepted me and respected me as a person. / N/A 1 2 3 4 5
29. / Supervisor was attentive to both my needs and the needs of my clients. / N/A 1 2 3 4 5
30. / Supervisor demonstrated a willingness and ability to deal with my personal dynamics when it was relevant to my counseling. / N/A 1 2 3 4 5
31. / Supervisor provided me with continuous feedback based on direct observation of my work. / N/A 1 2 3 4 5
32. / Supervisor applied fair criteria in evaluating my counseling skills and overall practicum/internship performance. / N/A 1 2 3 4 5
COMMENTS / N/A 1 2 3 4 5 / N/A 1 2 3 4 5
Please describe your supervisor’s notable strengths:
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Please describe any areas that need improvement:
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*Attach an additional page if necessary. / N/A 1 2 3 4 5
SIGNATURES
Instructor:______Date:______
Student:______Date:______

Revised 07/10/16 2