SCHOOL PSYCHOLOGY PRACTICUM OR INTERNSHIP STUDENT EVALUATION

Student                                                                   Site Supervisor                                                             Term:___________________

Site(s)                                                           Evaluator:  self     site supervisor     MSUM supervisor   Date of Eval. ___________

Directions:  Familiarize yourself with the ratings below, then read each item carefully and rate the student’s skill/behavior.  This form is used for a variety of practica and the internship, so all items will not be applicable for all situations.  Use the N/A rating if the item was not applicable to this particular practicum.  Please give examples or further comment in the “comments” section(s).

N/A – Not Applicable; Not an appropriate goal for a school psychology practicum in this setting

N/O – Not Observed; The skill is appropriate for this practicum/intership, but the rater did not observe the skill and is not familiar

                                    enough with the student’s skills in this area from supervision or feedback from others to give a rating

1 – Unsatisfactory; Student’s skills reflect insufficient mastery in this area; student needs additional instruction in this skill

2 – Needs improvement; Plans should be made to assure student gains extra practice in this skill prior to leaving the program

3 – Satisfactory; Student’s skills in this area are adequate for practice in schools’, student should continue to practice this skill       

                           under professional supervision

4 – Competent; Student is comfortably independent in this skill

5 – Outstanding; Student’s skills in this area are exceptionally strong; Student could be a model practitioner in this skill area

PERSONAL/PROFESSIONAL CHARACTERISTICS

N/A    N/O     1    2    3     4    5    1.  Uses defenses appropriately (i.e. is not overly critical of self nor defensive toward others)

N/A    N/O     1    2    3     4    5   2.  Demonstrates initiative, motivation, and follow-through

N/A    N/O     1    2    3     4    5  3.  Organizes own schedule and functions independently

N/A    N/O     1    2    3     4    5  4.  Is punctual and prepared

N/A    N/O     1    2    3     4    5  5.  Demonstrates appropriate professional dress and appearance

N/A    N/O     1    2    3     4    5  6.  Works constructively with others

N/A    N/O     1    2    3    4     5  7.  Works hard but protects self against burnout

N/A    N/O     1    2    3     4    5  8.  Demonstrates an awareness of competency level, and doesn’t accept responsibilities that 

                                                                exceed this level

N/A    N/O     1    2    3     4    5  9.  Maintains visibility and accessibility within assigned school(s)

N/A    N/O     1    2    3     4    5  10.  Demonstrates adaptability and flexibility

N/A    N/O     1    2    3     4    5  11. Demonstrates good judgment and common sense

N/A    N/O     1    2    3     4    5  12. Communicates and listens effectively

N/A    N/O     1    2    3     4    5  13. Utilizes feedback/constructive criticism

N/A    N/O     1    2    3     4    5  14. Demonstrates tolerance for others’ values and viewpoints

N/A    N/O     1    2    3     4    5  15.  Demonstrates the knowledge and sensibility needed to work with individuals of diverse          

                                                                 cultures and backgrounds

N/A    N/O     1    2    3     4    5  16.  Demonstrates the knowledge and sensitivity needed to work with individuals with

                                                                 disabilities

N/A    N/O     1    2    3     4    5  17.  Has knowledge of information sources and technology skills relevant to his/her work

Comments:

N/A –Not Applicable  N/O- Not Observed  1 – Unsatisfactory 2 – Needs improvement  3 – Satisfactory 4 – Competent   5 – Outstanding

INTERVENTION SKILLS

N/A     N/O    1    2     3    4    5  1.  Proposes intervention strategies that are directly related to the assessed problem

N/A    N/O     1    2    3     4    5  2.  Assists in evaluating the effectiveness of intervention techniques used

N/A    N/O     1    2    3     4    5  3.  Maintains empathy, objectivity, and problem focus

N/A    N/O     1    2    3     4    5  4.  Demonstrates skill in utilizing individual or group counseling techniques            

N/A    N/O     1    2    3     4    5  5.  Demonstrates skill in utilizing behavior modification & classroom management techniques

N/A    N/O     1    2    3     4    5  6.  Maintains confidence of the client and others involved

N/A    N/O     1    2    3     4    5  7.  Recognizes a client’s need for outside referral and is skilled in facilitating contact with

     appropriate resources

N/A    N/O     1    2    3     4    5  8.  Recognizes cultural implications when making intervention recommendations

Comments:

ASSESSMENT SKILLS

N/A    N/O     1    2    3     4    5  1.  Clearly identifies the nature of the referral problem and the purpose of the assessment

N/A    N/O     1    2    3     4    5  2.  Obtains pertinent pre-assessment information through interviews with appropriate persons

N/A    N/O     1    2    3     4    5  3.  Selects and administers appropriate observations, tests and scales, both formal and informal

N/A    N/O     1    2    3     4    5  4.  Analyzes and interprets observation and test results in a meaningful and thorough fashion

N/A    N/O     1    2    3     4    5  5.  Is sensitive to sources of bias, including cultural bias, when selecting & administering tests

N/A    N/O     1    2    3     4    5  6.  Follows standardized procedures in administering tests

N/A    N/O     1    2    3     4    5  7.  Integrates own data with that of others

N/A    N/O     1    2    3     4    5  8.  Works with a team in generating and supporting reasonable hypotheses

N/A    N/O     1    2    3     4    5  9.  Communicates assessment information effectively to relevant others

N/A    N/O     1    2    3     4    5  10. Maintains confidentiality of information collected during assessment

Comments:

REPORT WRITING SKILLS

N/A    N/O     1    2    3     4    5  1.  Writes, clear, concise, data-based reports

N/A    N/O     1    2    3     4    5  2.  Writes about student’s strengths as well as weaknesses

N/A    N/O     1    2    3     4    5  3.  Keeps reader(s) in mind when writing

N/A    N/O     1    2    3     4    5  4.  Reports are completed on time

Comments:

N/A –Not Applicable  N/O- Not Observed  1 – Unsatisfactory 2 – Needs improvement  3 – Satisfactory 4 – Competent   5 – Outstanding

CONSULTATION SKILLS

N/A    N/O     1    2    3     4    5  1.  Relates effectively to children and youth

N/A    N/O     1    2    3     4    5  2.  Relates effectively to teachers, administrators, and other school personnel

N/A    N/O     1    2    3     4    5  3.  Relates effectively to parents

N/A    N/O     1    2    3     4    5  4.  Demonstrates ability to work with people from other cultures

N/A    N/O     1    2    3     4    5  5.  Is non-threatening/non-authoritarian when consulting with school personnel and parents

N/A    N/O     1    2    3     4    5  6.  Is able to maintain objectivity and problem focus

N/A    N/O     1    2    3     4    5  7.  Demonstrates effective problem-solving skills

N/A    N/O     1    2    3     4    5  8.  Is skillful in presentation of information at child study and other staff meetings

N/A    N/O     1    2    3     4    5  9.  Serves effectively as a liaison for school and parents

N/A    N/O     1    2    3     4    5  10. Evaluates effectiveness of consultation strategies used

N/A    N/O     1    2    3     4    5  11. Communicates at the level of the consultee (e.g., avoids jargon when dealing with parents)

Comments:

Additional/Summary Comments:

Evaluator’s Signature: __________________________________  Date: ______________________________

For Site Supervisor’s Only: 

Based on your  supervision of this student, what do you recommend for a practicum/intern grade: _____ Pass       _____ No Pass