SCHOOL OF PSYCHOLOGY & COUNSELING
STUDENT EVALUATION
OF SITE SUPERVISION
Midterm OR
Final
Please select the appropriate degree level and mark the course below that best corresponds
with your Approved Degree Plan (ADP).
M.A. Counseling Practicum – COUN 523
M.A./Certificate of Graduate Studies Counseling Internship
COUN 593A
COUN 594A
COUN 595A
COUN 593B
COUN 594B
COUN 595B
The purpose of this evaluation is to allow the student to evaluate site supervision during practicum
and/or internship and to assess the progress of site supervision as they learn how one becomes an
effective mental health and/or school counselor. This evaluation also allows student to praise the site
supervisor or express concerns regarding site supervision. Please include additional comments on this
form or on a separate page that you think would help Regent University assess your experience.
Comments will not affect your grade in either practicum or internship.
Practicum/Intern Student Name:
_________________________
Practicum/Internship Site Name:
_________________________
Site Supervisor Name:
_______________
Date:
__________
Please answer the following questions about your practicum/internship site supervision:
1. Do you have an assigned site supervisor?
2. Who is your main supervisor?
Yes
No
_________________________
3. How much time do you receive in weekly one-to-one or triadic supervision?
4. Do you receive supervision in a group with other practicum/intern students?
a. If so, how many students are in the group?
_____
b. How many hours per week?
_____
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_____
Yes
No
5. Please describe the content and manner of your supervision sessions:
(i.e., content = what is covered and manner = feedback, how given)
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________
6. How would you describe your satisfaction with your supervision?
Excellent
Fair
Poor
If, on question# 6, you answered “fair” or “poor,” please explain why you answered this way and
provide some reasonable recommendations that would be useful to the site supervisor and to
the School of Psychology and Counseling:
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________________________
7. Have you discussed your level of satisfaction regarding your practicum/internship site with the:
Site Supervisor:
Yes
No
Faculty Supervisor:
Yes
No
8. Please indicate the number of hours you spent on the following counseling activities during the
semester:
CMHC/MCF Counseling
School Counseling
Individual Counseling
PreK – 6th Grade Individual Counseling
Group Counseling
7th – 12th Grade Individual Counseling
Family Counseling
PreK – 6th Grade Group Counseling
Couples Counseling
7th – 12th Grade Group Counseling
Assessments
PreK – 6th Grade Academic Counseling
Training/In-Services
7th – 12th Grade Academic Counseling
Research
Parent Consultation
Staff Meetings
Teacher Consultation
Site Supervision
Administrators Consultation
Faculty Group Supervision (class)
Parenting Group
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Administrative Duties
Classroom Observation
Other
Classroom Guidance Lessons
School-Wide Guidance
Assessments/Screening
Occupational/Vocational Counseling
Training/In-Services
Research
Staff Meetings
Site Supervision
Faculty Group Supervision (class)
Administrative Duties
Other
(Practicum/Intern Student Signature)
(Date)
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