OKLAHOMA STATE
UNIVERSITY – OKLAHOMA CITY
ALCOHOL
AND SUBSTANCE ABUSE COUNSELING DEGREE PROGRAM
FINAL PRACTICUM
EVALUATION
This
evaluation is to be completed by the Agency Supervisor and returned to the OSU-Oklahoma
City Practicum Instructor once the required 200 hours of practicum experience
has been completed.
Student Name:_________________________________________________________
Semester:_____________________________________________________________
Practicum
Site:_________________________________________________________
Site
Supervisor Name:___________________________________________________
SUPERVISOR: Please evaluate the student on each of the
listed dimensions using the rating scale below.
Give only one rating for each dimension.
Written comments are encouraged and are very useful to the student and
the practicum
Instructor.
1 = Outstanding
2 = Above
Average
3 = Average
4 = Below
Average
5 = Unsatisfactory
NA = No
knowledge – Does Not Apply
Once you
complete this evaluation, you are encouraged to go over it with the student.
I.
PROFESSIONALISM
NA 1 2 3 4 5 A) Adheres to ethics/confidentiality.
NA 1 2 3 4 5 B) Punctuality and time management.
NA 1 2 3 4 5 C) Adheres to Agency policies.
NA 1 2 3 4 5 D) Record keeping.
NA 1 2 3 4 5 E) Relations w/ staff.
NA 1 2 3 4 5 F) Participation in staff meetings.
NA 1 2 3 4 5 G) Dress and appearance.
NA 1 2 3 4 5 H) Overall professionalism.
COMMENTS:
II.
RESPONSE
TO SUPERVISION:
NA 1 2 3 4 5 A) Utilizes supervision effectively.
NA 1 2 3 4 5 B) Openness for critical comments.
NA 1 2 3 4 5 C) Effective use of supervisor's suggestions.
NA 1 2 3 4 5 D) Verbal and conceptual skills.
NA 1 2 3 4 5 E) Overall response to supervision.
COMMENTS:
III.
Overall
Evaluation: Please discuss student’s strengths, areas in
need of improvement, interpersonal skills, knowledge base, etc.
COMMENTS:
IV.
If
you were grading this person, what would you recommend based on the students overall
work performance? (Please circle)
A B C D F
Supervisor's
Signature:__________________________________________________
Site Name:____________________________________________________________
Date:________________________ Contact
#:_______________________
Please return
this form to: Lisa Dillon, Division Head
of Human Services
Public
Safety Training Center, Room 100
900
N. Portland
OKC,
OK 73107
(405)
945-3214 Office
(405)
945 6783 Fax