College of Education
Department of Educational Psychology
Supervised Internship Experiences
M.A. Counseling – Agency Supervisor End-of-Internship
Program Evaluation Form
Student’s Name (Last, First, MI):
Program: M.A. Counseling
NAU ID:
Campus: Choose an item.
Semester/Yr:
Agency Supervisor’s Name:
Agency Name:
DIRECTIONS: Based on your interactions with this intern, please rate the following in terms of how
well you feel that the training program has prepared the intern candidate for an internship in a
community agency setting. The original completed form is given to the faculty supervisor directly at the
end of the internship.
Below Average
1. Understanding of major counseling
theories.
Average
Above Average
1
2
3
4
5
6
2. Knowledge of a wide range of counseling
techniques.
1
2
3
4
5
6
3. Knowledge of current issues in the
profession.
1
2
3
4
5
6
4. Knowledge of legal codes and ethical
standards.
1
2
3
4
5
6
5. Intern’s ethical behavior.
1
2
3
4
5
6
6. Knowledge of how the site operates.
1
2
3
4
5
6
7. Intern’s creation and maintenance of
client records.
1
2
3
4
5
6
8. Intern’s conceptualization of clients.
1
2
3
4
5
6
9. Intern’s clinical skills ability.
1
2
3
4
5
6
10. Intern’s assessment skills.
1
2
3
4
5
6
Created: HGD, February 15, 2013
Student’s Name (Last, First, MI): ___________________________
NAU ID: ___________________
11. Intern’s administrative skills.
1
2
3
4
5
6
12. Knowledge of referral and related
resources.
1
2
3
4
5
6
13. Knowledge of roles of agency personnel
and operations.
1
2
3
4
5
6
14. Intern’s ability navigate professional
relationships.
1
2
3
4
5
6
Do you have additional comments about the strengths of the training program based on your interactions
with the NAU intern and faculty?
Do you have any suggestions for improvements or additions to the training program based on your
interactions with the NAU intern and faculty?
Agency Supervisor Signature: __________________________________ Date: ______________
Faculty Supervisor Signature: __________________________________ Date: ______________
Created: HGD, February 15, 2013