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Site Supervisors: By entering your name and email address in the text boxes, you are agreeing with the information provided in this web form.

Copies of this page will be sent to the email address you have provided, the Practicum/Internship students  EKU email address and to the EKU Department of Counseling office to maintain records. If you have any questions about the use or intent of these forms please contact EKU’s Counseling department at 859.622.1124

Ability to establish and maintain a productive counseling relationship.
Demonstrated appropriate skills, techniques and interventions.
Demonstrated the ability to identify and explore clients’ concerns, including diagnosis.
Assisted clients in setting goals.
Demonstrated the skill of assisting client problem-solving and decision-making.
Demonstrated flexibility in meeting individual client needs.
Showed a willingness to take risks.
Demonstrated the ability to lead or co-lead a group.

Please indicate student’s skill/performance levels in the following areas by checking the appropriate boxes, with (1) Poor, (2) Below Average, (3) Average, (4) Above Averaage, (5) Excellent, and (N/A) Not Applicable.

Commitment to the profession.
Communication skills.
Took initiative and worked independently.
Responded effectively to feedback, critique and suggestions. 
Practiced ethical behavior.
Developed a working relationship with staff.
Maintained client confidentiality.
Used appropriate referral sources.
Consulted with other professional staff regarding concerns.
Abided by institution/agency policies. 


A grade of “S” (satisfactory) indicates that in addition to completing all course requirements in a timely and professional manner, the student demonstrates strong counseling skills, has high standards of personal and professional behavior, demonstrates a willingness to learn, is cooperative and resourceful in his or her work environment and is committed to the counseling profession.

A grade of “U” (unsatisfactory) indicates that the student has not completed course requirements in a professional manner, needs to improve counseling skills, has less-than-acceptable professional and personal standards of behavior, appears to be unwilling to learn and lacks sufficient commitment to the profession. A grade of “U” is considered unacceptable in the internship program. A student receiving this grade will be asked to reconsider his or her choice of profession, or, if exceptional circumstances are proven, a second internship may be required prior to graduation and/or specific remediation may be required prior to the second internship assignment.

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