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).
Doctoral Practicum
CES 770
CES 771
CES 772
Doctoral Internship
CES 801
CES 802
CES 803
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?
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_____
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?
_____
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:
Individual Counseling
Consultation
Staff Meetings
Family Counseling
Supervision of Others
Administrative Duties
Group Counseling
Research
Site Supervision
Teaching
Training/In-Services
Class Supervision
Other
(Practicum/Intern Student Signature)
(Date)
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