Faculty Supervisor Evaluation Practicum

Faculty Supervisor Evaluation

Clinical Mental Health Counseling Practicum
Student Name

First NameLast Name
Student Email
example@example.com
Student ID
Semester/Year
Agency
Date

MonthDayYear
Date
Internship Site Supervisor
Internship Faculty Supervisor
Faculty Supervisor Email
example@example.com
Please select the appropriate number in light of what you would expect with other M.A. students at the same level of professional development. Please add comments for ratings of BE.

1 (BE) = Below Expectations

2 (PME) = Partially Meets Expectations

3 (ME) = Meets Expectations

N/A = No Basis for Judgment

*If there are serious concerns please note in comments
Demonstrates strategies for personal and professional self-evaluation and implications for practice (CACREP II.F.1.k).
Demonstrates an understanding of the impact of heritage attitudes, beliefs, understandings, and acculturative experiences on an individual's views of others (CACREP II.F.2.d).
Demonstrates an understanding of the counselor characteristics and behaviors that influence the counseling process (CACREP II.F.5.f).
Applies developmentally relevant counseling treatment and intervention plans (CACREP II.F.5.h).
Applies strategies to promote client understanding of and access to a variety of community-based resources (CACREP II.F.5.k).
Conceptualizes the role and process of the professional counselor advocating on behalf of the profession (CACREP II.F.1.d).
Comprehends the advocacy processes needed to address institutional and social barriers that impede access, equity, and success for clients (CACREP II.F.1.e).
Demonstrate interpersonal skills, insightfulness, self-awareness, and empathy that are necessary for the effective conduct of clinical mental health interventions.
Demonstrates ability to benefit from supervision as well as the skills and confidence to work independently when appropriate.
Demonstrates a respectful and non-judgmental attitude toward all persons and valuing of that which brings them health and wholeness.
Demonstrates a valuing of mental health work as an outreach of the individual Christian and of the church.
Recording Reviewed?

YesNo
Date Reviewed

MonthDayYear
Date
Live Observation Submitted (in lieu of recording)?

YesNo
Date of Live Observation

MonthDayYear
Date
Phone/Email Consultation with the Site Supervisor (in addition to written Site Supervisor Evaluations)
Content of Phone/Email Consultation:
Date of Consultation

MonthDayYear
Date
Faculty Supervisor Comments:
Student Strengths:
Student Growth Areas:
Please comment on any of the above issues or any other perceptions on your assessment of this student's current or future capabilities as a mental health professional. An overall assessment of the student’s present and future capabilities as a mental health professional would also be helpful.
Additional Comments:
Faculty Supervisor Signature:
Date

MonthDayYear
Date
Student Signature:
Date

MonthDayYear
Date
Should be Empty: