College of Education
Department of Educational Psychology
Supervised Internship Experiences
M.A. Counseling – Intern Feedback for NAU Faculty
(Must be typed)
Intern Name (Last, First, MI):
NAU ID:
Program: M.A. Counseling
Campus:
Agency Name:
Semester/Yr:
Mid-Point
Final
NAU Faculty’s Name:
DIRECTIONS: The intern is to complete this evaluation form at the mid-point of the internship. After
completion, hand this to your NAU Faculty Supervisor.
Strongly Disagree
Agree
Strongly Agree
2
3
4
5
1
2
3
4
5
3. Accepted & respected me as a person.
1
2
3
4
5
4. Facilitated a process that provided me
with feedback about my strengths &
weaknesses.
1
2
3
4
5
5. Was consistent & flexible in supervision.
1
2
3
4
5
6. Encouraged me to engage in professional
behavior.
1
2
3
4
5
7. Provided clarifications & resource
information upon request.
1
2
3
4
5
8. Facilitated the application of criteria in
evaluating my performance fairly.
1
2
3
4
5
9. Facilitated group supervision effectively
1
2
3
4
5
1. Provided me with an understanding of
the procedures of the internship.
1
2. Was available to answer questions.
Additional comments or suggestions:
Intern Signature: ___________________________________
Faculty Signature: ___________________________________
Chair Signature: _______________________________
Date:______________
Date:______________
Date:______________
Revised: HGD, June 22, 2015