@! REGENT UNIVERSITY SCHOOL OF PSYCHOLOGY & COUNSELING SITE SUPERVISOR EVALUATION OF STUDENT Midterm OR Final Please select the appropriate degree level and mark the course below that best corresponds with your Approved Degree Plan (ADP), I MA. Counseling Practicum ~ COUN 523 (1 MAA. Counseling Internship (J coun s94a, 1 coun s9sa Bd coun 5948 CJ coun sose ‘The purpose of this evaluation isto allow the site supervisor to assess the student's progress in a clinical Tield experience such as practicum and/or internship. This evaluation also serves as a guide since It enables the site supervisor, the student, and Regent University to define what constitutes quality work, From the evaluation, a site supervisor assesses a student's strengths and challenge areas based on ‘specific criteria so that the student becomes more aware of how one produces quality work, Please feel free to include detailed comments on this form or on a separate page that you think would help the student improve his or her counseling abilities. Practicum/Intemn Student Name: Tracey Miller Practicurn/Internship Site Name: King’s Ridge Christian School Practicum/Internship Site Supervisor Name: —_Susan.Day Date: 03/03/2015. RATING SCALE: 12 Area of strength; continue to work on it Potential for development; needs further tralning Average performance; needs further training Area af weakness; needs considerable improvement Major weakness; lack of training ond skill = Not applicable Page 1 of 4PERSONAL AND PROFESSIONAL RESPONSIBILITIES; Punctuality/attendance during practicum/internship respons Ability to follow through and complete tasks Ability to meet deadlines Takes responsiblity for actions Shows initiative; willing to be involved Adheres to ethical practices Practices sensitivity to diversity issues Presents a favorable appearance Keeps appropriate records Has learned about agency or school programs, polices, and resources Can make appropriate community referrals Cooperates with other staff and co-workers ies 1 IOS I De I IN ‘SUPERVISION: Consistently meets with supervisor ‘Open to new ideas and techniques Handles constructive criticism well ‘Shows appropriate insight into own behaviors Able to organize materials into written reports, case summaries, and other written communications Able to make clear oral reports and verbally expresses self well a9 se IN OD ck types of supervision used: EX written reports [student self-report direct observation ideo recordings DD audio recordings co-therapy COUNSELING SKILLS: Please evaluate student using the Rating Scale above in the following section(s) {choose one); ‘Community/Clinical Counseling Schoo! Counseling Able to gather relevant information 1 Comfortable in the classroomn/schoot during intake session environment Appropriately uses support and 2 Appropriately uses support and empathy skills empathy skills Displays good non-verbal attending Displays good non-verbal attending skills skills Able to identify present and root 3 Effective in classroom/school guldance problems 1 Focuses on the content of the student's Uses silence effectively problem Page 2of 4 | |Plans and conducts effective group counseling Confronts effectively when necessary Begins and ends each session appropriately Establishes and maintains appropriate boundaries with clients Develops, organlzes, and initiates treatment plan(s) Makes accurate diagnoses Faclitates establishment of realistic client goals Conceptualizes problems theoretically Possesses current knowledge of Issues, trends, and techniques in the field 4s knowledgeable and competent in computer technology associated with counseling Self-discloses appropriately Manages initiation and termination of client sessions Manages emergent events professionally ‘Acts as social advocate for client(s) ‘Manages transference and counter- transference Issues Knowledgeable of referral procedures and requirements ‘Acts ethically in all aspects and requirements of counseling responsibilities Other noteworthy skills (Please List) 3 i 1 nm mom 2 Page 3 of 4 Plans and conducts effective group counseling. Confronts effectively when necessary Begins and ends each session smoothly Establishes and maintains appropriate boundaries with students Facilitates realistic goal setting with students Encourages appropriate action step planning with students Facilitates establishment of realistic student goals, Conceptualizes problems theoretically Possesses current knowledge of issues, trends, and techniques in the field Is knowledgeable and competent in ‘computer technology associated with school counseling Selfadlscloses appropriately ‘Manages initiation and termination of school counseling sessions ‘Manages emergent events professionally Acts as social advocate for student(s)/parent{s)/school Manages transference and counter- transference issues, Knowledgeable of referral procedures and requirements Acts ethically in all aspects and requirements of counseling responsibilities Facilitates student expression of concerns and feelings Communicates with parents, teachers, and administrators in facilitative manner Other noteworthy skills (Please List)OTHER COMMENTS: Tracey is a pleasure to work with because she Is willing to learn different ways of doing things, thas been a blessing to have her working with our high school students. Site Supervisor Signature: Practicum/Intern Student Signature: pate: O-D-IS THANK YOU for your assistance as a stipervisor for the School of Psychology & Counseling practicum/internship students. We appreciate your time and commitment. The student is responsible for returning this evaluation form to the faculty supervisor. Page 4 of 4