MID-TERM EVALUATION Student _ Kristen Kisner__Semester _ Fall Year 2015 Site Supervisor: Lisa Boyle Email Address: _|iSAboy!e. 365 1],com Faculty Supervisor: Monica Leppma Please contact me regarding concerns I have about this student. Yes_\_No (phone: ) Best time to call: Site_wost Fawment Middle School Period of evaluation: From August 17,2015 through October 02. 2014 Is this a [MIDTERM or END OF SEMESTER evaluation? (please circle) Evaluation based on (please check all that are relevant); _X_ Individual Supervision ___ Group Supervision Case Discussion (team or unit meetings, case conferences, etc.) ____ Training Sessions ___ Review of Tapes (Audio or video) _X__ Observation of Sessions, ____ Co-Counseling of Cases Other (please specify)Direet Service Counseling: 45 hours required for a full semester of practicum 240 hours required for a full semester of internship (30 of the 45 hours for practicum and 150 of the 240 hours for internship must be individual counseling with clients who have presenting problems of sufficient depth and intensity as to lend themselves to the practicum student's or intern’s professional development. Other direct service hours may be group, intake, vocational, etc). Individual Counseling Nous 9 13 Group Counseling Hours wo Other Direct Service Hours ___ly .@5" Supervi Students are required to meet with their site supervisor for 1 hour of supervision per week Supervision Hours US Supervision with faculty supervisor 1) Seer Pare Group supervision (practicum or internship ‘mectings) g q All Other Counseling Activities: Includes all hours in related activities, program coordination, etc., that are not included in the above categories Related Activities Hours 428 Sum of Hours to Date ‘Total hours that the student has completed since beginning the placement, 100 total required hours for practicum, 600 total required hours for internship Total Hours 45.60 Please rate the student according to the following scale, being as fair and objective as possible. Because practicum students and interns are in various sites, including schools, community agencies, and private settings, some of the following items may not apply toyour students. Respond only to those items, which apply. ‘This evaluation is meantto be shown to the student and used for their skill development, Thank you for your cooperation.Student demonstrates: Attitude toward Work Excellent | Strong | Average | Weak Unable to rate Ability to wake iniiative and perform independently v ‘Promptness ‘Dependability Daily preparation ‘Cooperativeness “Ability to carry out suggestions ‘Willingness to carry out suggestions, “Asks for assistance when needed ‘Willingness to share extra duties “Maintains good rapport with colleagues ‘Coniributes to meetings, seminars, ete. AASINSSISISS) Willingness to learn ‘Student demonstrates: Excellent | Strong | Average | Weak ‘Poor ‘Unable to rate SelFawaroncss and self understanding Emotional sability ‘Self-control ‘A sonse of adequacy, self-worth, and self- confidence “The capacity to accept and profit from constructive criticism, v Z v a ‘Actively seeks supervision when necessary “Ability fo communicate clearly and effectively. v Ability to be tactful “Ability to grasp and successfully adapt to now situations Y Excellent | Strong | Average | Weak Poor Unable to rate ‘Student demonstrates: Genuine interest in clients s ‘Ability to understand client’s point of View Ability to secure cooperation of clients in Individual and group settings Ability to maintain confidentialityExcellent Strong “Average Weak Poor | Unable to rate ‘Student demonstrates: ‘Ability to establish and maintain rapport “Ability to successfully relate to diverse types of clients ‘An awareness of and adherence to ethical standards ‘An understanding of developmental stages and tasks of clients Ability to use/develop appropriate activity ‘media in counseling and classroom guidance Ability to accurately assess the educational and/or psychological needs of clients Ability to match individual needs to appropriate individual and/or group settings and services Ability to use appropriate appraisal techniques for the gathering and utilization of information Ability to use educational, vocational, and personal-social information in assisting clients with the skill of decision-making, ‘Ability to facilitate communication with # resistant or non-voluntary client ‘Ability to identify and respond to feelings “Ability show client support, even iin disagreement Ability to relate effectively to clients who are physically challenged Encourages independent action “Ability o show disapproval of a behavior ‘without rejecting a client "Ability to handle client’s attempts to ‘manipulate ‘Ability (o establish, work toward, and assess ‘counseling goals, ‘Demonstrates skill in organizing groups “Ability to facilitate group interactions “Ability to understand and evaluate group progress KANSISISINN AN SESE SSSA‘Student demonstrates: ‘Excellent | Strong | Average | Weak [Poor | Unable to i | rate ‘Abily to organize @ counseling programm appropriate tothe seting schoo! or ageney) ‘Knowledge of community referral sources Ability to desiga and present effective classroom lessons | Knowiedge of any tests used inthe setting and their proper interpretation ‘Ability to effectively consult with parents, teachers, and other necessary parties Ability to interact productively with oiher personnel inthe settin ‘Ability to interact productively with other personnel in the settin Ability to function as a team meniber ‘An overall understanding of the organization and functions ofthe school or agency INNS SSNS Stadent demonstrates Excellent | Strong | Average | Weak Poor | Unabiew ‘ate ae i Counseling ability v Fee Bea Coordination abil Z | Consultation ability Z Pottial for overall sates ava Tare 7 counselor in a setting similar tothe site Please respond to the following: Identify areas that may be considered strengths for this student. Kristen ts willing to do anuthing, reguasted + Shaves icas. She isa cravtve thinker, Identify areas that may be considered weaknesses for this student She shill hesitates when she is unsure of heesel F of & sifuation, \ut she has great strength ant Potentio| dhak tr am cackaia will show tn all si}uedtons in Hine: Do you feel this student would be more suited to a different setting? If yes, what kind of setting? eS ara apeeas to be ee able + hondk any Setting *‘What recommendations do you have for this student? : Step out, Follow through va] your great ‘has. certify that I have completed this evaluation and discussed it with the student. DoaShoyd ol [Is Site Supervisor's Signature Date I certify that I have reviewed this evaluation with my site supervisor. HentorK vant, whLic tudent’s Signature Date Return to: Kelly Webber Department of Counseling, Rehabilitation Counseling and Counseling Psychology P.O. Box 6122 Morgantown, WV 26508 Phone: 304.293.3808 Facsimile: 304.293.4082 Scan a signed copy and send by email to Kelly. webber@mail.wwu.edu