OKLAHOMA STATE
UNIVERSITY – OKLAHOMA CITY
ALCOHOL
AND SUBSTANCE ABUSE COUNSELING DEGREE PROGRAM
MID-TERM EVALUATION
This
evaluation is to be completed by the Agency Supervisor and returned to the
OSU-Oklahoma City Practicum Instructor once 100 of the required 200 hours of
practicum experience have been completed.
Student Name:_________________________________________________________
Semester:_____________________________________________________________
Practicum
Site:_________________________________________________________
Site
Supervisor Name:___________________________________________________
SUPERVISOR: Please circle the appropriate response for
each item using the following key:
1 = Outstanding
2 = Above
Average
3 = Average
4 = Below
Average
5 = Unsatisfactory
NA = No
knowledge – Does Not Apply
Attitude –
positive, non-judgmental 1 2 3 4 5 NA
Judgment –
maturity of behavior 1 2 3 4 5 NA
Ability to
Learn – eager, learns quickly 1 2 3 4 5 NA
Dependable –
fulfills obligations 1 2 3 4 5 NA
Utilizes
supervision well 1 2 3 4 5 NA
Relates well
to others 1 2 3 4 5 NA
Appearance –
neat and appropriate 1 2 3 4 5 NA
Attendance –
regular and prompt 1 2 3 4 5 NA
What do you
see as the student’s greatest strengths relating to this placement?
What area(s)
do you think the student needs to give attention to?
Would you
like to meet with course Instructor regarding this student’s placement?
YES NO
Supervisor
Signature:________________________________________________
Student
Signature:___________________________________________________
Instructor
Signature:__________________________________________________