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School:
__________________________________________
Title:
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Directions: Use the rubrics from the West Virginia School Counselor Performance
Standards Handbook to self-reflect on your performance level related to each function and determine
areas of weaknesses to set appropriate annual goals.
Unsatisfactory
Year:
Emerging
__________________________________________
Accomplished
Name:
Distinguished
Standards Self Assessment and Evidence Form
Standard 1: Program Planning, Design and Management. The professional school
counselor collaboratively plans, manages and designs the comprehensive, developmental school
counseling program.
Overall
Function 1A: PROGRAM PLANNING - Plans a balanced comprehensive school counseling program.
Function 1B: PROGRAM DESIGN - Designs a balanced comprehensive school counseling program.
Function 1C: PROGRAM MANAGEMENT - Manages a comprehensive school counseling program.
Function 1D: STAKEHOLDER COLLABORATION – Collaborates with stakeholders to plan and manage the school counseling
program.
Evidence
Brief Description
Comments
 Comprehensive School Counseling Plan
 Self-evaluation
 Daily, Weekly, Monthly Calendars
 Strategic plan
 Disaggregation results data
 Technology integration
 Electronic log data (WVDE example)
 Needs assessment
 Program planning notes
 Counselor use of time log
 Portfolio
 Action plans
 Lesson plans*
 Advisory council minutes
 Communication/correspondence tools
 Surveys (parents, teachers, students)
 Grant applications
 Other relevant evidence
Unsatisfactory
Emerging
Overall
Accomplished
Standard 2: Program Delivery. The professional school counselor facilitates delivery
of the WV Comprehensive Developmental School Counseling Program for all students.
Distinguished
Standards Self Assessment and Evidence Form
Function 2A: PROGRAM DELIVERY - Ensures the delivery of a comprehensive, developmental school counseling program aligned
with West Virginia Board of Education policy.
Function 2B: RESEARCHED BEST PRACTICES - Utilizes research-based best practices to deliver individual and group counseling and
classroom guidance curriculum.
Function 2C: GUIDANCE CURRICULUM - Facilitates delivery of a comprehensive guidance curriculum to meet the developmental
needs of all students.
Function 2D: INDIVIDUAL STUDENT PLANNING - Coordinates an ongoing systemic approach to assist individual students in
establishing personal goals and develop future plans.
Function 2E: RESPONSIVE SERVICES - Provides a continuum of interventions in response to student needs.
Function 2F: STUDENT SUPPORTS - Assists in developing comprehensive student supports within the school and community to
support academic, career, and personal/social development of all students.
Function 2G: SUCCESSFUL TRANSITIONS – establishes student supports for successful transitioning through programmatic levels, and
from school to school, school to work, or school to post-secondary, or career and technical training.
Evidence
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Brief Description
Comments
Counselor curriculum map by grade level
Curriculum crosswalks
Lesson plans
Evidence of guidance integration in
relevant courses and programs
Daily, weekly, monthly calendars
Action plans
Observations
Peer reviews
School crisis plan
Group counseling documents
Referral forms
Student intervention plan
School mental health plan
Early intervention documentation
Needs assessment
Prevention program documents
Programmatic grade level transition plans
SAT, IEP, 504, MDT meeting documents
Workshops for parents, teachers, and
stakeholders
Agendas and sign-in sheets
End of year participation survey
ASCA crosswalk
ISTP plans
Grade level portfolios
Graduation checklists
Notes in student records
Individualized data from standardized tests
Learning styles/interest inventories
Other relevant evidence
WCSCPS - Standards Self Assessment and Evidence Documentation Form – Page 2
Function 3A: PROGRAM RESULTS - Uses data to measure the results and impact of the school counseling program.
Function 3B: PROGRAM COMPLETENESS - Evaluates the degree to which the school counseling program is implemented
and aligned to West Virginia Board of Education policy.
Evidence
Brief Description
Comments
 School Counseling Program Audit
 Advisory council notes
 Counselor self assessment
 School data
 Students needs assessment results
 Surveys
 Operational schedules
 Website
 Pre and post test data
 Logs
 Annual school counseling report
 CFWV usage reports
 Other relevant evidence
WCSCPS - Standards Self Assessment and Evidence Documentation Form – Page 3
Unsatisfactory
Emerging
Overall
Accomplished
Standard 3: Data Driven Accountability and Program Evaluation. The professional
school counselor examines school, student, and program data to annually evaluate school
counseling program results and to assure program completeness.
Distinguished
Standards Self Assessment and Evidence Form
Function 4A: STUDENT ADVOCACY - Advocates for success of ALL students.
Function 4B: STAKEHOLDER TRAINING - Facilitates appropriate training for stakeholders and staff related to school
counseling program mission.
Function 4C: PROGRAM ADVOCACY - Advocates for and promotes the comprehensive school counseling
program.
Evidence
 Referral documentation to programs
and resources
 Longitudinal course enrollment data
 Disaggregated data
 Policy documents
 School programs, agendas, outlines,
sign in sheets
 Student progress towards post
secondary
 Document of student re-entry
strategies
 Transition strategies documentation
 Stakeholder meetings notes agendas,
sign in sheets
 Advisory council meeting notes,
agenda, sign in sheets
 Logs documenting interactions
including but not limited to: families,
agencies, counselors, school nurses,
social workers, DHHT, school
psychologists, school sponsors, athletic
directors/coaches, employers, elected
officials, policy makers, military, etc.
Brief Description
Comments
Other relevant evidence
WCSCPS - Standards Self Assessment and Evidence Documentation Form – Page 4
Unsatisfactory
Emerging
Overall
Accomplished
Standard 4: Leadership and Advocacy. The professional school counselor assumes a
leadership role in advocating for student and program success.
Distinguished
Standards Self Assessment and Evidence Form
Function 5A: Knowledge and Skills - Enhances knowledge and skills to advance professional practice.
Function 5B: Legal and Ethical Practices - Adheres to professional ethical standards, policies, and laws in conduct and in
practices.
Function 5C: Growth of Profession - Contributes to growth of the school counseling profession.
Evidence
Brief Description
Comments
 Documentation of participation in:
conferences, workshops, webinars
 Professional growth goals
 Counselor evaluation
 Self appraisal
 Action plans
 Attendance certificates
 Proof of enrollment
 Graduate courses, online courses
 Proof of teaching undergraduate or
graduate courses
 Professional newsletters, journals, etc.
 ASCA code of ethics
 FERPA guidelines
 County policy related to confidentiality
and professional practices
 Mission statement, philosophy, and
beliefs
 Observations
 Surveys and feedback
 School Protocols
 Other relevant evidence
WCSCPS - Standards Self Assessment and Evidence Documentation Form – Page 5
Unsatisfactory
Emerging
Overall
Accomplished
Standard 5: Professional Growth and Responsibilities. The professional school
counselor is responsible for improving skills and knowledge and advancing his/her practice
and the school counseling profession.
Distinguished
Standards Self Assessment and Evidence Form