FNS: 302
Interview and Counseling Evaluation Form
In addition to the written evaluation that is due with your interview and counseling
tape (see part C of the Video Taping Assignment Instructions you received the
first day of class), use the following checklist to evaluate your performance. Your
peers and I will use this same checklist when evaluating your videotape later in
the semester.
Choose the number that most closely describes your/your classmate’s
performance during the interview and counseling sessions:
1. Needs Improvement
2. Adequate to obtain the information needed
3. Good application of principals and techniques discussed in class and
in readings.
4. Very good application of principals and techniques discussed in class
and readings
Record your assessment score for each component below:
Name of interviewer: _______________________________________________
INTERVIEW
_____1. Interviewer effectively uses non-verbal communication (relaxed, inviting
behavior, tries to put client a t ease) comments:
_____2. Interviewer demonstrates good listening skills (use of wait time, minimal
encouragers) Comments:
_____3. Interviewer summarizes information gathered from the client.
Comments:
_____4. Interviewer demonstrates appropriate subjectivity to client responses (no
judgment against food or lifestyle choices) Comments:
_____5. Interviewer uses good open minded questioning skills. Comments:
_____6. Interviewer uses good probing skills to gather information. Comments:
Oral Communication Skills
_____7. Interviewer is dressed appropriately (professional attire) Comments:
_____8. Interviewer exhibits poise and confidence. Comments:
_____9. Interviewer maintains eye contact with the client. Comments:
_____10. Interviewer’s voice is clear and audible. Comments:
______11. Interviewer conveys content clearly (flows well) Comments:
_____12. Interviewer avoids the use of “uh” or “um” Comments:
Name of Evaluator: _______________________________________________
(will be removed before returning the form to the student whom you evaluated)