Music Therapy Internship Site Evaluation

Name of Music Therapy Intern*

First NameLast Name

University*

Dates of Internship*

Ranking Scale: 1 = Strongly Agree

2 = Mildly Agree

3 = Neither Agree or Disagree

4 = Mildly Disagree

5 = Strongly Disagree

NA = Not applicable

Directions: Read each statement and determine the degree to which you agree or disagree with each statement. Note that evaluation of each item involves determining whether the experiences were provided as stated in the Clinical Training Proposal and the quality of such experiences. If you have rated an item a 4 or 5, please include a comment.

I. Provisions for orientation

1. My orientation to the agency/facility was provided to me as specified in the Clinical Training Plan.*

2. My orientation to the facility was adequate for my needs.*

3. My orientation to the AMTA Standards of Practice, organizational structure, Code of Ethics, and Clinical Training Guidelines was provided to me as specified in the Clinical Training Plan.*

4. My orientation included a verification procedure-specifying acknowledgement of expectations and competencies, beyond those stated in the company policy.*

Comments about the orientation phase of the internship:

II. Provisions for the music therapy experience

5. My internship was provided to me as described in the Clinical Training Plan.*

6. My opportunities for observation experiences of music therapy sessions were adequate for my needs.*

7. My opportunities for co-leading of music therapy sessions were adequate for my needs.*

8. My opportunities for leading sessions were adequate for my needs.*

Comments on the music therapy experience

III. Provisions for records and progress notes

9. My opportunities for learning the process of completing documentation requirements such as behavior charting, progress notes and other facility documentation wereadequate for my needs.*

10. My schedule allowed adequate hours to complete behavior charting, progress notes, lesson plans and other documentation.*

Comments on behavior charting, progress notes, assessments, class descriptions, goals and objectives, behavior charting, lesson plans, MTI research project:

IV. Provisions for Staff and In-Service Meetings

11. My internship provided me with opportunities to attend staff and in-service meetings, which were adequate for my needs.*

12. My attendance at staff and in-service meetings was helpful.*

13. My participation at staff meetings was respected, well received, and considered active and professional by the treatment team members.*

Comments on staff and in-service meetings:

V. Provisions for intern self-awareness and professional growth

14. My opportunities for intern self-awareness and professional growth were adequate for my needs.*

15. My self-awareness and professional growth assignments were helpful.*

16. My internship allowed me the opportunities to develop my own personal style.*

Comments on intern self-awareness and professional growth:

VI. Provisions for observation of intern sessions and providing feedback

17. My opportunities for informal and formal observations were adequate for my needs. *

Comments on formal and informal observation:

VII. Provisions for supervision

18. My total supervision opportunities were adequate for my needs.*

19. My total supervision time per week was at least one hour.*

20. My supervisor or a designated therapist was available outside the one-hoursupervision time if I needed extra assistance.*

Comments on supervision:

VIII. Provisions for administrative skills

21. My opportunities for developing administrative skills, such as budgets, were adequate for my needs.*

Comments on administrative skills:

IX. Provisions for special requirements

22. My internship provided me with the special requirements (i.e. MTI research project,repertoire collection book, etc.) described in the Clinical Training Plan.*

23. My opportunities for special requirements were adequate for my needs.*

Comments on special requirements:

X. Provisions for Academic training

24. Meet the entrance requirements/entry level skills for this internship placement.*

25. Use music in a therapeutic manner.*

26. Plan, adapt and create activities and sessions.*

27. Act professionally and responsibly.*

28. Act in an ethical manner with clients.*

29. Express my professional opinions verbally.*

30. Express my professional opinions in writing.*

31. Deliver music therapy services according to the AMTA Standards of Practice.*

32. Deliver music therapy services to three or more clinical populations.*

33. Develop a personal music therapy philosophy and theory of practice.*

34. Understand and use time management skills and the ability to prioritize tasks. *

Comments on Academic training: