Department of Educational Psychology
Field-Based Practicum Experiences
Counselor-in-training Evaluation Form for Field-Based Practicum Experiences
Counselor-in-training: Evaluation Date:
Site Supervisor: Faculty Supervisor:
Name of Site:
Person Filling out Form (check one): Site Supervisor Counselor-in-training
Date of Placement: to Number of Hours:
Mo/Yr Mo/Yr
Directions: The Site Supervisor and the counselor-in-training will each complete one of these forms and share the ratings with each other and the Faculty Supervisor. The completed evaluation forms will be provided to the Faculty Supervisor upon completion of the Practicum. The same form will be used for both the mid-point and final evaluations. Please use the following rating scales during the evaluation process.
5 (Superior): Consistently exhibits skills and knowledge that are superior for a counselor-in-training.
4 (Above Average): Consistently exhibits skills and knowledge that are above average for a counselor-in-training.
3 (Average): Consistently exhibits skills and knowledge that are average for a counselor-in-training.
2 (Needs Improvement): Consistently exhibits skills and knowledge that need to be improved.
1 (Unsatisfactory): Consistently exhibits skills and knowledge that are unsatisfactory for a counselor-in-training.
Work Skills / Mid-Point / Final1. Plans and organizes time effectively.
2. Produces accurate, neat, thorough work
3. Expresses self well in oral and written work.
4. Is punctual and dependable.
5. Works harmoniously with coworkers.
6. Responds well to post-session supervision.
7. Responds well to live supervision and/or review of audio/video supervision.
8. Adheres to site policies and procedures
Counselor-in-training Evaluation Form for Field-Based Practicum Experiences, continued
Professional Counselor-in-training Skills and Behavior / Mid-Point / Final9. Assessing and Diagnosing Client Problems
Examples:
10. Individual Counseling
Examples:
11. Group Work
Examples:
12. Family/Parent Counseling
Examples:
13. Ethical and Professional Behavior
Examples:
14. Ability to Work with Diverse Clients
Examples:
15. Report Writing / Record Keeping
Examples:
16. Case Conference / Staff Presentation
Examples:
17. Other Skills
Examples:
Overall Evaluation
Counselor-in-training Evaluation Form for Field-Based Practicum Experiences, continued
Mid-Point Evaluation
Strengths of the Counselor-in-training
1.
2.
3.
Areas to Improve and Activities to Improve These Areas
1.
2.
3.
Final Evaluation – Date:
Strengths of the Counselor-in-training
1.
2.
3.
Areas to Improve and Activities to Improve These Areas
1.
2.
3.
Rater’s Signature and Credentials Date
Revised: HGD, 12-22-16