FINALEVALUATION

PhD in REHABILITATION COUNSELING and REHABILITATION COUNSELOR EDUCATION

Course: Practicum Internship I Internship II

Student’s Name: / Banner ID:
Supervisor’s Name:
Physical Address:
Email Address:
Phone (work): / ( ) - / Phone (cell): / ( ) -

Evaluation of practicum/internship student by the Site Supervisor included assessment/evaluation through the following modalities (check all that apply):

Live observation of student with client/clients
Review of recorded student work with client/clients
Case staffing with student
Collaboration and consultation with other practitioners at site
Client satisfaction feedback/measurement
Other (Describe)

Please rate the intern’s performance in the appropriate domains with

“1” being “Unsatisfactory” performance and “5” being “Superior”.

1
No Evidence of mastery of the criterion area / 2
Limited mastery of the criterion area- below expectation / 3
Adequate mastery of the criterion area at the Doctoral level / 4
Above Average mastery of the criterion area / 5
Excellent mastery in the criterion area - exceeds most peers / N/A
No Opportunity to Complete
COUNSELING
  1. scholarly examination of theories relevant to counseling
/ 1 2 3 4 5 N/A
  1. integration of theories relevant to counseling
/ 1 2 3 4 5 N/A
  1. conceptualization of clients from multiple theoretical perspectives
/ 1 2 3 4 5 N/A
  1. evidence-based counseling practices
/ 1 2 3 4 5 N/A
  1. methods for evaluating counseling effectiveness
/ 1 2 3 4 5 N/A
  1. ethical and culturally relevant counseling in multiple settings
/ 1 2 3 4 5 N/A
SUPERVISION
  1. purposes of clinical supervision
/ 1 2 3 4 5 N/A
  1. theoretical frameworks and models of clinical supervision
/ 1 2 3 4 5 N/A
  1. roles and relationships related to clinical supervision
/ 1 2 3 4 5 N/A
  1. skills of clinical supervision
/ 1 2 3 4 5 N/A
1
No Evidence of mastery of the criterion area / 2
Limited mastery of the criterion area- below expectation / 3
Adequate mastery of the criterion area at the Doctoral level / 4
Above Average mastery of the criterion area / 5
Excellent mastery in the criterion area - exceeds most peers / N/A
No Opportunity to Complete
SUPERVISION (continued)
  1. opportunities for developing a personal style of clinical supervision
/ 1 2 3 4 5 N/A
  1. assessment of supervisees’ developmental level and other relevant characteristics
/ 1 2 3 4 5 N/A
  1. modalities of clinical supervision and the use of technology
/ 1 2 3 4 5 N/A
  1. administrative procedures and responsibilities related to clinical supervision
/ 1 2 3 4 5 N/A
  1. evaluation, remediation, and gatekeeping in clinical supervision
/ 1 2 3 4 5 N/A
  1. legal and ethical issues and responsibilities in clinical supervision
/ 1 2 3 4 5 N/A
  1. culturally relevant strategies for conducting clinical supervision
/ 1 2 3 4 5 N/A
TEACHING
  1. roles and responsibilities related to educating counselors
/ 1 2 3 4 5 N/A
  1. pedagogy and teaching methods relevant to counselor education
/ 1 2 3 4 5 N/A
  1. models of adult development and learning
/ 1 2 3 4 5 N/A
  1. instructional and curriculum design, delivery, and evaluation methods relevant to counselor education
/ 1 2 3 4 5 N/A
  1. effective approaches for online instruction
/ 1 2 3 4 5 N/A
  1. screening, remediation, and gatekeeping functions relevant to teaching
/ 1 2 3 4 5 N/A
  1. assessment of learning
/ 1 2 3 4 5 N/A
  1. ethical and culturally relevant strategies used in counselor preparation
/ 1 2 3 4 5 N/A
  1. the role of mentoring in counselor education
/ 1 2 3 4 5 N/A
RESEARCH AND SCHOLARSHIP
  1. research designs appropriate to quantitative and qualitative research questions
/ 1 2 3 4 5 N/A
  1. univariate and multivariate research designs and data analysis methods
/ 1 2 3 4 5 N/A
  1. qualitative designs and approaches to qualitative data analysis
/ 1 2 3 4 5 N/A
  1. emergent research practices and processes
/ 1 2 3 4 5 N/A
  1. models and methods of instrument design
/ 1 2 3 4 5 N/A
  1. models and methods of program evaluation
/ 1 2 3 4 5 N/A
  1. research questions appropriate for professional research and publication
/ 1 2 3 4 5 N/A
  1. professional writing for journal and newsletter publication
/ 1 2 3 4 5 N/A
  1. professional conference proposal preparation
/ 1 2 3 4 5 N/A
  1. design and evaluation of research proposals for a human subjects/institutional review board review
/ 1 2 3 4 5 N/A
  1. grant proposals and other sources of funding
/ 1 2 3 4 5 N/A
  1. ethical and culturally relevant strategies for conducting research
/ 1 2 3 4 5 N/A
LEADERSHIP AND ADVOCACY
  1. theories and skills of leadership
/ 1 2 3 4 5 N/A
  1. leadership and leadership development in professional organizations
/ 1 2 3 4 5 N/A
  1. leadership in counselor education programs
/ 1 2 3 4 5 N/A
1
No Evidence of mastery of the criterion area / 2
Limited mastery of the criterion area- below expectation / 3
Adequate mastery of the criterion area at the Doctoral level / 4
Above Average mastery of the criterion area / 5
Excellent mastery in the criterion area - exceeds most peers / N/A
No Opportunity to Complete
LEADERSHIP AND ADVOCACY (continued)
  1. knowledge of accreditation standards and processes
/ 1 2 3 4 5 N/A
  1. leadership, management, and administration in counseling organizations and other institutions
/ 1 2 3 4 5 N/A
  1. leadership roles and strategies for responding to crises and disasters
/ 1 2 3 4 5 N/A
  1. strategies of leadership in consultation
/ 1 2 3 4 5 N/A
  1. current topical and political issues in counseling and how those issues affect the daily work of counselors and the counseling profession
/ 1 2 3 4 5 N/A
  1. role of counselors and counselor educators advocating on behalf of the profession and professional identity
/ 1 2 3 4 5 N/A
  1. models and competencies for advocating for clients at the individual, system, and policy levels
/ 1 2 3 4 5 N/A
  1. strategies of leadership in relation to current multicultural and social justice issues
/ 1 2 3 4 5 N/A
  1. ethical and culturally relevant leadership and advocacy practices
/ 1 2 3 4 5 N/A

UNIVERSITY SUPERVISOR COMMENTS:

COURSE INSTRUCTOR COMMENTS:

DOCTORAL INTERN COMMENTS:

Student Signature: ______Date: ______

Course Instructor Signature: ______Date: ______

University Supervisor Signature: ______Date: ______

Version 6