SCHOOL OF PSYCHOLOGY & COUNSELING
STUDENT EVALUATION
OF PRACTICUM/INTERNSHIP SITE
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 help the student evaluate the quality of the site during practicum or
internship, so that the student may understand how a site can foster learning that allows students to
develop the knowledge, values, and skills necessary for clinical mental health and/or school
environments. Please feel free to include comments on this form that you think would help improve the
quality of the site. Comments will not affect your grade in either practicum or internship.
Practicum/Intern Student Name:
_____________________________________________
Practicum/Internship Site Name:
_____________________________________________
Site Address:
_____________________________________________
_____________________________________________
Site Supervisor’s Name:
_____________________________________________
Faculty Supervisor’s Name:
_____________________________________________
Dates of Internship/Practicum: FROM:
_____
TO:
(Month)
_____ (Month)
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_____
(Day)
_____ (Year)
_____ (Day)
_____ (Year)
Please answer the following based on your practicum/internship site:
1. Give a brief summary of your site, including the population serviced and the services offered.
___________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. What were the most positive aspects of this practicum/internship site and your experiences
there?
___________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
3. What were the negative aspects?
___________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
4. Would you recommend this site to future interns and/or practicum students?
Definitely
Yes, but with hesitation
No
Please explain:
___________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
Rate the following questions about your internship site and experience:
1 = Excellent
2 = Moderately Satisfactory
3 = Average
4 = Moderately Unsatisfactory
5 = Very Unsatisfactory
N/A – Not applicable
Amount of on-site supervision
Quality and usefulness of on-site supervision
Relevance of experience to career goals
Exposure to and communication of practicum/internship site goals
Exposure to and communication of practicum/internship site policies and procedures
Exposure to professional roles and functions within the practicum/internship site
Exposure to information about community resources
Overall evaluation of site
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Please mark the activities in which you were involved at your practicum/internship site:
Individual Counseling
Personal/Social
Occupational/Educational
Couples Counseling
Family Counseling
Crisis Counseling
Academic Counseling
Group Counseling
Co-Leading
Leading
Record Keeping
Testing
Analysis & Administration
Interpretation of Results
Individual Supervision
Grand Rounds
Treatment Plans
Assessments & Screenings
School Counseling Activities
Student Orientations
Classroom Guidance Activities
School-wide Guidance Activities
Guidance Reports
Parent Conferences
Child Study Team Meetings
Administrative Conferences
Case Conferences
Staff Meetings
In-Services
Psycho/Educational Activities
Career Counseling
Intake Interviewing
Report Writing
Resource Management
Outreach
Follow-up Programs
Referrals
Community Resources
Computer Technology (Counseling use)
Other (please specify):
(Practicum/Internship Student Signature)
(Date)
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