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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