INTERNSHIP EVALUATION FORM - Baylor University A 实习评价表-贝勒大学.doc

INTERNSHIP EVALUATION FORM School Psychology Program Baylor Date: _______________ Semester: ________ Year: ______ Student: ________________________ Supervisor: _______________________ To the Field Supervisor: Please complete this evaluation form and go over it with you student in a personal conference. Use a licensed school psychologist (LSSP) as your base for making the ratings. Provide as much specific feedback as possible. Thank you for your time in supervising this student. If you have any questions please contact Eric L. Robinson, Ph.D. at (254) 710-4796 or by e-mail: Eric_Robinson@baylor.edu. PROFESSIONAL CONDUCT 1. General Interpersonal Skills (Circle number that best corresponds to the student’s skills) 1 3 5 7 9 Interpersonal skills Displays adequate Displays exceptional have negative effect interpersonal skills interpersonal skills on others 2. Punctuality 1 3 5 7 9 Missed at least Missed deadline Punctual one deadline or but made appropriate appointment arrangements 3. Makes Use of Feedback 1 3 5 7 9 Overly defensive to Somewhat defensive Receptive to appropriate feedback or does not feedback and or fails to change change behavior makes behavior behavior as a result adequately changes 4. Ethical Behavior 1 3 5 7 9 Engaged in Engaged in Engaged in unethical behavior questionable behavior ethical behavior 5. Learned New Skills 1 3 5 7 9 Has made no effort Has made an effort Has made consistent to develop skills to acquire skills but did efforts to learn new beyond those already do so in a way which was approaches, styles, etc. known ineffective or which resulted in little new learning ASSESSMENT SKILLS 6.