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1、INTERNSHIP EVALUATION FORMSchool Psychology ProgramBaylor UniversityDate: _ Semester: _ Year: _ Student: _ Supervisor: _To the Field Supervisor: Please complete this evaluation form and go over it with you student in a personal conference. Use a licensed school psychologist (LSSP) as your base for m
2、aking the ratings. Provide as much specific feedback as possible. Thank you for your time in supervising this student. If you have any questions please contact Eric L. Robinson, Ph.D. at (254) 710-4796 or by e-mail: Eric_Robinsonbaylor.edu.PROFESSIONAL CONDUCT1. General Interpersonal Skills(Circle n
3、umber that best corresponds to the students skills)13579 Interpersonal skillsDisplays adequateDisplays exceptional have negative effect interpersonal skills interpersonal skills on others2. Punctuality13579 Missed at leastMissed deadline Punctual one deadline or but made appropriate appointmentarran
4、gements3. Makes Use of Feedback13579 Overly defensive to Somewhat defensive Receptive to appropriate feedback or does not feedback and or fails to change change behaviormakes behavior behavior as a result adequately changes4. Ethical Behavior13579 Engaged in Engaged in Engaged in unethical behaviorq
5、uestionable behaviorethical behavior5. Learned New Skills13579 Has made no effort Has made an effortHas made consistent to develop skillsto acquire skills but didefforts to learn new beyond those alreadydo so in a way which wasapproaches, styles, etc. knownineffective or which resultedin little new
6、learningASSESSMENT SKILLS6. Intern follows standardized testing procedures during assessment13579 Strongly DisagreeStrongly Agree 7. Interpretation of Psychological Evaluation Results13579 Unclear presentation Presents results clearly Well integrated of results, no integration but without integratio
7、n interpretation/ presentation8. Ability to integrate information into a written report. 1 3 5 7 9 Is not able to Adequate ability Exceptional ability integrate information to integrate information to integrate information9. Ability to create cognitive and academic goals for student based on assessm
8、ent. 1 3 5 7 9 Unable to Adequate ability Exceptional ability create goals to create goals to create goals 10. The intern is able to implement interventions and achieve designated goals based on the assessment.1 3 5 7 9 Unable to Adequate ability Exceptional ability implement interventions to implem
9、ent interventions to implement interventions11. The intern is able to evaluate the effectiveness of interventions developed from the designated goals. 1 3 5 7 9 Unable to Adequate ability Exceptional ability evaluate effectiveness to evaluate effectiveness to evaluate effectiveness12. Ability to int
10、egrate assessment information orally (to parents, teachers, etc.) 1 3 5 79 Unable to Adequate ability Exceptional ability integrate information to integrate information to integrate informationPREVENTION/INTERVENTION SKILLSNote to Supervisor: The follow section is divided into three parts: Counselin
11、g, Consultation, and General Intervention.13. General COUNSELING skills with Students 1357 9 Poor Fair Average Above Excellent Average14. Ability to create therapeutic goals for students in counseling setting. 1 3 5 7 9 Unable to Adequate ability Exceptional ability create goals to create goals to create goals 15. The intern is able to implement interventions and achieve designated goals in counseling setting.1 3 5 7 9 Unable to Adequate ability Exceptional ability implement interventions to implement interventions to implement interventions16. The
