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Evaluation of Doctoral Student in Supervision PracticumNorth Carolina State UniversityCounselor Education ProgramStudent Name:_________________________________________________________Supervision Instructor:____________________________________________________________Please rate the student according to the following scale based on the different areas of his/her professional development1 (Poor); 2(Below Average); 3(Average); 4(Above Average); 5(Excellent); N(No opportunity to observe)A. PERSONAL CONDUCT Poor Below Av. Av. Above Av. Excellent NSelf Awareness 12 345 NEmotional Stability 12 345 NSelf Control 12 3 45 NCooperativeness 12 345 NAdaptability 12 345 NAbility to be a teamPlayer 12 345 NGeneral Comments on personal characteristics:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________B. INTERPERSONAL SKILLS With other colleagues/peers 12 345 NWith Site Supervisors 12 345 NWith Supervisees 12 345 NWith Course Instructor/s 12 345 NGeneral Comments on interpersonal skills: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________C. PROFESSIONAL BEHAVIORDependability 12 345 N Poor Below Av. Av. Above Av. Excellent NUse of Suggestions 12 34 5 Nand constructivecriticismPromptness 12 345 NAbility to work independently 12 34 5 NWillingness to assumeresponsibility 12 345 NInitiative 12 345 NCross Cultural Competence/Multicultural Sensitivity 12 34 5 NGeneral Comments on professional behavior: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________D. COUNSELING KNOWLEDGE BASECounseling theory andresearch 12 345 NLegal and Ethicalstandards 12 345 NKnowledge of specificintervention techniques 12 345 NKnowledge of developmental theory 12 345 NGeneral Comments on counseling knowledge base:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________E. COUNSELING SKILLS AND PROCESS IN SUPERVISIONGenuine interest in supervisee 12 345 NAbility to understand the supervisee’s point of view 12 345 NAbility to relate to diverse supervisees 12 345 NAbility to establishand maintain rapport 12 345 N Poor Below Av. Av. Above Av. Excellent NAbility to assess andhave insight into supervisee’s problems 12 345 NDemonstrates effective helping skills (paraphrasing,feeling reflection, summarizing,effective probing etc.) 12 345 NGeneral Comments on counseling skills and process:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________F. TECHNICAL COMPETENCEAssessment andevaluation skills 12 345 NImplementation ofindividual counselingtechniques 12 345 NImplementation of group counselingtechniques 12 345 NAbility to plan and implement developmentalactivities for supervisees 12 345 NAbility to establishand implementconsultation relationships 12 345 NGeneral Comments on technical competence:____________________________________________________________________________________________________________________________________________________________________________G. SUPERVISION (Using the same scale above, put the appropriate number on the line beside the item.)A. Knowledge.Understands the purposes of clinical supervision. (A.1.) _______Understands theoretical frameworks and models of clinical supervision.(A.2.)________Understands the roles and relationships related to clinical supervision.(A.3.) _________Understands legal, ethical, and multicultural issues associated with clinical (A. 4.)______supervision.B. Skill/Practices.1. Demonstrates the application of theory and skills of clinical supervision.(B1.) ______2. Develops and demonstrates a personal style of supervision.(B.2.) ______General comments on supervision competence:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________H. OVERALL RATING OF STUDENT 12 345 NPlease comment on the two following questions:What are the greatest strengths of the student?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What areas need further development?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Supervision Instructor’s Signature_______________________________________________________Doctoral student supervisor _______________________________________________________________Date____________________________________________________________________________________________ ................
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