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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:__________________________________________________