GRADUATE STUDENT EXTERN EVALUATION FORM
Student:__________________________Date of evaluation:____________________
Site:_____________________________Supervisor:__________________________
Check one:
Check one:
□ First full-time internship
□ Midterm evaluation
□ Second full-time internship
□ Final evaluation
Caseload includes (check all that apply):
Age groups:
□ Early childhood (birth-grade 2)
□Middle Childhood (grades 5-9)
□ Childhood (grades 1-6)
□ Adolescence
□ Adult
Disorder types/Areas Addressed:
□ Phonology/Articulation
□Fluency □Voice
□ Language
□ Cognitive aspects of Communication
□AAC/AT
□ Social communication
□ Aural Rehab
□Hearing screenings
□ Feeding/swallowing
□ High-risk population (specify) ______________________________________
***** □ Culturally/linguistically diverse population: specify in detail the backgrounds
of those students with whom the intern worked:
_______________________________________________________________________
Knowledge and Skills (CCC Standards)
Demonstrates understanding of the organizational structure and chain of
command (ASHA CCC Standard IV-G-3)
Interprets assessment data accurately (IC-G-1-e)
Generates functional treatment goals appropriate to needs of client (IV-G-2-a)
Chooses procedures and materials appropriate to treatment objectives (IV-G-2c)
Implements therapy in an efficient and accurate manner (IV-G-2-b)
Documents client performance in an efficient and accurate manner; daily SOAP
notes if appropriate (IV-B; IV-G-2-f)
Demonstrates understanding of social aspects of communication (III-D)
Utilizes suggestions from families and patient in treatment programming (IV-G2-g)
Accurately and appropriately explains information and procedures to patient
and families or caregivers (IV-G-3-a; IV-G-3-c)
Presents information in a conference format in a clear and understandable
manner (IV-G-3-a; IV-G-3-d)
Demonstrates professional behaviors including timeliness and dress appropriate
to environment (III-E; III-G; IV-G-3-d)
Contributes information and resources to the team (IV-G-3-b)
Is able to problem solve as needed or find the resources to effectively cope with
the problem (IV-G-3)
Deals with conflict in a professional manner (IV-G-3)
Adheres to Code of Ethics and other practice guidelines (IV-G-3)
0
Skill Not
Apparent
1
Emerging
2
Adequate
3
Strong
SUMMARY
Please add comments on the reverse or on a separate page as needed.
1. Student’s Growth:
□ Substantial
□ Moderate
□ Minimal
Comments:
2. Level of independence relative to student status:
□ Exceptional
□ Adequate
Comments:
□ In need of continued supervision
3. Ability to handle documentation demands:
□ Accurate and efficient
□ Adequate (feedback helpful) □ Guidance needed
Comments:
4. The student showed a strong theoretical foundation for the placement:
5. The student was able to apply treatment procedures appropriately:
6. The student demonstrated critical thinking and problem-solving skills:
7. The student maintained professional and ethical behaviors:
Please comment on any “No” responses:
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
Additional comments (use reverse or attach as needed):
Recommended grade:__________
_____________________________________
Supervisor
________________________________
Student