Clinical Program Annual Performance Appraisal STUDENT SELF-ASSESSMENT FORM (revised December 2010)

of 6 Clinical Program Annual Performance Appraisal STUDENT SELF-ASSESSMENT FORM (revised December 2010) Please complete this form and submit it along with a copy of your curriculum vitae to your academic advisor by May 1st Purpose. The purpose of this form is to facilitate students annual reporting of activities to clinical program faculty and to promote student self-assessment of progress in scholarship, teaching, research, clinical skills, and professional development. This information will be used as part of students annual evaluation in the clinical program and for accreditation reporting purposes. Ratings. For each component that is applicable, indicate whether you believe you are exceeding, meeting, or not meeting the program s expectations for amount of work and quality of performance. Ratings should consider the program s minimum levels of achievement (described below), your graduate program (MA or PhD), your year in that program, and any mitigating circumstances (e.g., illness; lack of financial support). Minimum expectations for achievement. Listed below, the clinical program has identified minimum levels of achievement for different training activities. We expect that students will normally perform well above these minima. However, to ensure that all students are aware of our expectations for progress we have provided explicit descriptions of our minimum expectations. Levels of achievement that fall below the minimum in any area will trigger a formal review process that may result in a remediation plan, and in very concerning situations, dismissal procedures. Coursework: Overall grade point average of B (3.0); C+ grade in each course taken. Candidacy examination: Overall grade of pass as determined by committee. Thesis completion activity: Completion of at least one substantial step toward thesis completion (see Table 1, below) and progress that is consistent with expectations for timely completion of thesis. Minimum expectation for timely completion is considered to be no more than 3 years for the Masters thesis and 6 years for the Ph.D. thesis from program entry. A rating of meeting expectations therefore reflects progress that is consistent with completing the thesis within these timeframes. Other research activity: Completion of at least one research activity that is in addition to the core research requirements outlined in Table 1 (from Table 2, below). Clinical training: At least one clinical training activity must be completed each year in the program (see Table 3, below) along with satisfactory ratings of 2 or higher on all Practicum Evaluation Rating Forms. Does not apply to first year Masters students. Ethics: The occurrence of any of the following signals a performance below minimum expectations: (a) acting in violation of the CPA Code of Ethics, (b) jeopardizing professional judgment through self-interest, or (c) demonstrating behaviour with respect to other students, colleagues, faculty or the public which is exploitative, irresponsible, or destructive (from the Department of Psychology s Professional Unsuitability By-Law). Professional Development/Continuing Education: All students who are enrolled in their first 3 years of the clinical program are expected to attend at least two departmental colloquia or job talks per term.

of 6 Clinical Program Annual Performance Appraisal: Student Self-Assessment Form (revised October, 2010) Student: Date: Program and Year: (e.g., PhD 3) Full-time or part-time status: Academic advisor: Thesis advisor: Not meeting program Expectations (unsatisfactory) Meeting program Expectations (satisfactory) In completing this form, please make use of the following rating scale: Past Year Scholarship Performance Exceeding program Expectations (good to very good) Not Applicable 1 2 3 N/A List courses completed and grades achieved in space below Rating: 1 2 3 N/A Describe status of candidacy examination in space below Rating: 1 2 3 N/A Have you received any awards, fellowships, accolades or other forms of recognition for your scholastic achievement? Yes No If yes, please specify: Past Year Teaching Performance Describe teaching and/or grader/marker activities in space below Rating: 1 2 3 N/A Have you received any awards for excellence in teaching? Yes No If yes, please specify:

of 6 Past Year Research Performance Thesis progress Rating: 1 2 3 NA Table 1. For each of item below: (a) check those that were completed in the past year; (b) when the task was completed, or (c) the date you anticipate completing the task: Steps Toward Completion Regular (monthly+) meetings with research advisor* Literature review completed* Completed thesis proposal development course Successfully proposed thesis Received ethics approval Completed data collection Submitted complete draft of thesis Submitted final draft of thesis Successfully defended thesis Date completed Check those completed in past year Anticipated completion date *Only first year students may claim these activities alone represent meeting expectations. Students beyond first year must complete other steps to be meeting expectations. Other research activity Rating: 1 2 3 NA Table 2. For each of the following research activities that are in addition to the core activities required for thesis completion, indicate the number you have completed in the past year: Other Research Activities Conference presentations Peer-reviewed publications Other publications Internal U of M fellowships applied for Internal U of M fellowships received External fellowships applies for External fellowships received Research assistantship Grant-supported research projects participated in Honours students co-supervised # complete in past year On the back of this page provide a brief self-assessment of progress made on thesis and in development of research competencies.

of 6 Past Year Clinical Performance Practica progress Rating: 1 2 3 NA Non-practicum clinical activity Rating: 1 2 3 NA Ethical knowledge, judgment, and behaviour Rating: 1 2 3 NA Table 3. List the number of the following clinical training experiences completed in the past year. Clinical training experiences* # in past year Practica completed Practica currently underway but not completed Attendance at clinical inservices Participation in clinical workshops *All students beyond their first year in the program who have not yet completed internship are expected to be engaged in clinical training activity each year. Practica details (use back for additional practica completed/in progress) Total practica completed to date: Total hours accumulated to date: Practicum # Completed: (Y N) Hours: Supervisor: General or specialty (if specialty describe): Self-assessment of performance: Any unsatisfactory ratings?: Practicum # Completed: (Y N) Hours: Supervisor: General or specialty (if specialty describe): Self-assessment of performance: Any unsatisfactory ratings?: On the back of this page provide a brief self-assessment of professional development in the areas of clinical skills and ethical knowledge/judgment/behavior.

of 6 Past Year Professional Development/Continuing Education Performance Table 4. Indicate the number and type of scholarly training or professional development activities undertaken. Note that attendance at clinical inservices or training workshops is to be listed under clinical training experiences in Table 3 (above). Activity # in past year Attendance at colloquia or job talks* Participation in teaching workshops Attendance at academic conferences Attendance at professional conferences Other (specifiy): * All students who are enrolled in their first 3 years of the clinical program are expected to attend at least two departmental colloquia or job talks per term. Have you completed the Certification in Higher Education Teaching (CHET) Program? Yes No Number of memberships in professional/scientific societies: Past Year Service Performance Please describe any service (administrative) contributions you may have made in the past year (e.g., participation in Graduate Association of Students in Psychology committees, or in university committees at the Departmental, Faculty, or University level; administrative roles in professional societies; etc.) Mitigating circumstances Please describe any mitigating circumstances (e.g., illness, lack of financial support, external employment) that have affected your progress through the program over the past year, and how you plan to manage or mitigate these circumstances in the future (use the back of this page if needed).

of 6 Did you have paid employment outside the university in the past year? Yes No If yes, please list details for each paid position worked in the past year: Employer: Duties: Period of Employment (from X to X): Average hrs/week: Employer: Duties: Period of Employment (from X to X): Average hrs/week: Employer: Duties: Period of Employment (from X to X): Average hrs/week: Overall self-evaluation The primary goal of our clinical program is to train competent and successful scientist practitioners and to graduate students in a timely manner. Taking into consideration your progress in scholarly, research-related, clinical, and professional activities over the past year, in what ways do you feel that you are, or are not, moving toward this goal. Include your most significant accomplishments here? What are your plans for the coming year to improve your scholarly, research, clinical, and/or professional skills, and progressing with your program? Rate your overall performance according to program expectations: 1 2 3 N/A Rate your overall performance according to your own expectations: 1 2 3 N/A Student: Signature: