Western Kentucky University Department of Counseling and Student Affairs School Counseling Site Supervisor Evaluation Form

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1 Western Kentucky University Department of Counseling and Student Affairs School Counseling Site Supervisor Evaluation Form Student Name: : Site Supervisor s Name: Name of Site: Please indicate Course: Practicum Internship I Grade Levels: Internship II This evaluation is for: Midterm Final Evaluation of Semester The site supervisor will complete this form at the midterm and at the end of each semester. Mark the number to the right of each item that best describes your perceptions of the intern s skill compared to all other people you have trained at the same level of professional development. The term client as used herein refers to any person receiving services including students, parents, or teachers. Counseling Skill Competency 1. Establishes a working relationship with clients. 2. Establishes relevant counseling goals with or for clients. 3. Evaluates clients progress with respect to goals. 4. Facilitates clients resolution of concerns. 5. Appropriately refers and terminates clients. 6. Understands theoretical principles as applied to particular client problems. 7. Understands diverse cultural, ethnic, sexual and social backgrounds and values of clients. IO = Inadequate Opportunity to Observe NR = Not Relevant to the Setting

2 8. Demonstrates ethical behavior in the counseling activity and case management. 9. Demonstrates competence in creating and implementing a career transition plan. Supervision Competency 1. Meets with supervisor as scheduled. 2. Engages in open, comfortable and clear communication with peers and supervisors. 3. Accepts and uses constructive feedback to enhance self-development and counseling skills. 4. Open to growth and learning. Deficient Expectations Outstanding Case Management Skill Competency 1. Aware of community resources. 2. Appropriately uses referrals within and outside the site. 3. Consistently schedules and meets with clients. 4. Keeps adequate and timely client records. 5. Consults with other staff regarding client needs. 6. Fulfills administrative responsibilities of the position.

3 Professional School Counseling Skill Competency 1. Demonstrates knowledge of the relationship between the school counseling program and the other functioning units and personnel in the school. 2. Demonstrates leadership skills, which enhance the learning environment of the school. 3. Demonstrates knowledge of the school setting, climate, curriculum, and current issues impacting the school environment. 4. Displays sensitivity to cross cultural issues in the school and community as well as opportunities and barriers to student development. 5. Identifies and consults during ethical and legal issues. 6. Utilizes individual and small group counseling, and classroom guidance approaches to promote student success in school. 7. Exhibits advocacy skills for all students, the school counseling program, the profession, and self. 8. Demonstrates skill in coordination, collaboration, referrals, and team building with the various stakeholders associated with the school. 9. Displays effort toward integrating the school counseling program into the total school curriculum. 10. Demonstrates skill in individual, family and school crisis prevention programs and intervention strategies.

4 11. Engages in planning, developing, implementing, monitoring, and evaluation of the counseling program. 12. Displays leadership skills in using schoolbased data to improve student outcomes. 13. Exhibits ability to implement and evaluate strategies to meet program goals. 14. Able to identify student needs and implement processes or activities to help students achieve. 15. Uses technology to design, implement, monitor, and evaluate the school counseling program. 16. Manages issues affecting the development or functioning of students (e.g., LD, ADHD, ADD, ODD, etc.). 17. Recognizes how systems and relationships interact to influence students and each other. 18. Recognizes and assists students who may use alcohol and/or other drugs. 19. Uses consultation strategies to enhance teamwork within the school and community. Based on your experiences, what would you evaluate as being the student s major strengths?

5 Suggestions for further professional development: Signature of Site Supervisor Signature of Faculty Supervisor My signature indicates I have read and discussed the above material with my site and faculty supervisors. It does not indicate my total or partial agreement with the evaluation. Signature of Practicum/Intern Student Instructions for completing this form: 1. Save this form to your computer. Save with the file name: Your Last Name + Your First Initial + Supervisor Mid or Final Eval + MonthYear. For example, JohnsonLSupervisorMidEval Electronically send the entire document to your Site Supervisor. Ask the Site Supervisor to complete the form on their computer, re-save it in the same format, and then it back to you. 3. Electronically send the completed form to your Practicum or Internship Instructor/Supervisor and the School Counseling Clinical Coordinator with your electronic portfolio at the end of the semester.

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