SUPERVISOR'S EVALUATION OF WFU CLINICAL MENTAL HEALTH COUNSELING

PRACTTCUM/t NTERNSH I P STU DENT

Supervisor or E University Supervisor

Site

EI

Practicum

or ll

tnternship Site

Midterm evaluation
Fall/2015

or

Finalevaluation

Student's name
Your name

_Arianne

_April

_Life

Synergy

Semester/year

Broadnox

Thornton

Please rate the student on the following scale:

Excellent = 5, Strong = 4, Average = 3, Weak = 2, Poor = 1

Personal Characteristics

Student Demonstrates:

Excellent

Awareness and

Strong

Average

Weak

Poor

Unable to
Rate

Strong

Average

Weak

Poor

Unable to
Rate

understanding of self
EmotionalStability
Self-Control

Appropriate Selfconfidence
Ability to accept and use

feedback
Clear and effective

communication
Tact

Ability to understand and

adapt to change
Attitude towards clients

*
Excellent

Genuine interest in
clients

Ability to understand
other person's point of
view

Capacity to build

cooperation of clients in
individual and group
settings
Sup ervi s or Ev aluat io

n of

P r ac ti

um/Int er ns hip S tucle nt

Any additional thoughts or feedback related this student's personal characteristics?

Arianne is a pleasure to work with. She presents very well with clients and staff. She is a positive
individual and shows interest in the field of counseling. Arianne is a very eloquent speaker and
exhibits her skills in sessions. Arianne is confidant in who she is a person and counseling intern. She is
approachable and has beautiful inviting spirit.

Please rate the student on the following scale:

Excellent = 5, Stront = 4, Average = 3, Weak = 2, Poor = 1

Counseling Skills

Student Demonstrates:

Excellent

Ability to establish and

maintain relationships
Cultural competence and
se nsitivity
Ability to gauge the
needs of the client
Ability to identify and
respond to feelines
Ability to match client
needs to intervention
Ability to establish, work

Strong

Average

Weak

Poor

Unable

to

Rate

*
*
*

toward and assess

counseling goals

Ability to understand and

adapt to change in the
relationship
Ability to understand
other person's point of
view and express
empathy
Ability to maintain
confidentia litv
Seeks supervision when
necessa ry
Skill in organizing groups
Ability to lead group
intera ctions

Ability to understand and

*
*
*

Supervisor Evaluation of Practicum/Internship Student 2

eva

luate group progress

Any additional thoughts or feedback related to this student's counseline skills?

Arianne is eager to learn and has a desire to be an excellent counselor. The skills that she currently
posses are excellent! Arianne takes the time to research and learn new forms of treatment approaches
for the purpose of meeting the needs for the clients and advancing herself.

Please rate the student on the following scale:

Excellent = 5, Strong = 4, Average = 3, Weak = 2, Poor = 1

Attitude Toward' ll\lork

Student Demonstrates:

Excellent

lnitiative

suggestions
Asks for help when
needed
Willingness to share extra
d uties
Good relations with all

Contributions in
meetings, etc.
Willingness to learn
Curiosity about
procedures and policies

Appreciation for
differences in work styles
Ability to work
independently

Average

Weak

Poor

Unable
Rate

to

Promptness

Dependabilitv
Cooperation
Ability to carry out

Strong

*
*
*
*
*
)*

*
,t

*
*

Any additional thoughts or feedback related to this student's attitude towards work?

Supervisor Evaluation of Practicum/Internship Student

Please rate the student on the following scale:

Excellent = 5, Strong - 4, Average = 3, Weak = 2, Poar = L

Student Demonstrates:

Excellent

Strong

Average

Weak

Poor

Unable
Rate

to

Ability to organize work

according to the setting
needs
Knowledge of referral
process and sources
Knowledge of
assessments used in
setting and proper

*
*

interoretation
Ability to consult with
appropriate sources
Ability to interact
productively with all

*
*

personnel

Ability to function as a
team member
Overall understanding of
the organization and
functions
Ability to advocate for
clients
Ability to use data to
guide decisions about
work and effectiveness
Seeks supervislon when

*
:la

*
:r

necessarv

Any additional thoughts or feedback related to this student's performance of orogram duties?

Supentisor Evaluation of Practicum/Internship Student 4

Please rate the student on the following scale.

Excellent = 5, Strong = 4, Average = 3, Weak = 2, Poor = 1

Strong

Excellent
Personal

fit for

Average

Weak

Poor

Unable
Rate

to

,r

counselins
*

Counseling ability
Work Habits
Knowledge of field

:r

Potential for success

Based upon your clinicaljudgment, at this point in the semester, how would you grade this student's

overall performance as compared to other students at the same point in their training (check one):

rA trA- EB+ trB trB-

EIC+

trC trC-

trF

ldentify areas you consider to be strengths for this student.

Completing intake and assessments.
Diagnosing
Developing case form ulations.

Determining the course of treatment for patients.

Educating clients and parents on treatment approaches and their progress in treatment.

ldentify areas for this student that you consider to need further development.
App lying interactive interventions

uring treatment

Supervisor Evaluation of Practicum/Internship Student 5

/A'3-eor{
Date

Supervisor's signature

niversity Supervisor's signature

/Ji ?- 9or a
Date

Date

Supervisor Evaluation of Practicum/Internship Student 6