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Midterm Evaluation of Internship Student By Site Supervisor

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

Section A

Please indicate student’s skill/performance levels in the following areas by checking the appropriate boxes, with (1) being low and (5) being high. Open-ended comments are requested on the last page of the evaluation.

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Maintains a helpful counseling relationship.
Refrains from being judgmental.
Individual counseling skills.
Family counseling and therapy skills.
Group facilitation skills.
Listening skills.
Use of open-ended questions/responses.
Good use of confrontation, questions, clarification.
Ability to identify and explore problems.
Ability to diagnose.
Assists clients through stages of problem solving.
Ability to develop a treatment plan.
Maintains client focus on topic.
Ends counseling sessions effectively.
Refers clients to appropriate sources if necessary.
Section B

Please indicate student’s skill/performance levels in the following areas by checking the appropriate boxes, with (1) being low and (5) being high. Open-ended comments are requested on the last page of the evaluation.

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Commitment to the profession.
Practices ethical behavior.
Maintains client confidentiality.
Working relationship with staff.
Consults appropriately regarding concerns.
Acceptance of supervision.
Initiative in learning new skills.
Practical judgment.
Punctuality.
Self-confidence.
Communication skills.
Conscientious.
Responsible.
C. Comments

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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