CLINICAL TRAINING PROGRAM
GRADUATE STUDENT ANNUAL REVIEW
To: Clinical Students
From: Grayson Holmbeck, Ph.D., Director of Clinical Training
Subject: Annual Review of Graduate Students
Date:
At the next clinical faculty meeting, the clinical training program will review the progress of all students in your class. In order for our
review to be accurate, we need information from you as soon as possible. Please provide me and your advisor with the information
on the following pages ASAP. An electronic email response is preferred. Email it as an attachment to me and your advisor, or
provide it in written form, (one copy to me, and one copy to your advisor). Then set up a meeting with your advisor before the next
faculty meeting to discuss your progress.
You will notice that there are two parts to the form: (1) the Annual Student Review Form, and (2) the Faculty/Advisor Review of
Student Progress. At this time, I am asking you to complete the first part. Then you e-mail the entire form (including the second part,
which will be blank) to me and to your advisor (as described above). You will complete this second part with your advisor prior to the
faculty meeting. Your advisor will bring this form to the faculty meeting and complete the portions referred to as “Faculty Comments
during Student Review” during the faculty meeting. Your advisor will then return the form to you for additional comments (“Student
Comments in Response to Faculty Comments”) and your signature.
Please save a version of this document in your personal files so that next year you can simply add to what you’ve already done. From
this point on your will only have to update the material each year. This information is important as it becomes part of your permanent
database and will be used to document your training during the doctoral program and in later years as you seek licensure and
employment positions.
Please also submit a current CV to me and your advisor: An electronic version is preferred.
Thank you for your prompt response.
Annual Review Form / page 1
ANNUAL STUDENT REVIEW FORM
BACKGROUND INFORMATION
NAME:
TODAY’S DATE:
ETHNICITY:
GENDER:
YES / NO
MASTER’S DEGREE PRIOR TO LOYOLA?
IF YES, SCHOOL:
DATE DEGREE COMPLETED:
DATE YOU BEGAN AT LOYOLA:
YEAR IN PROGRAM:
EMAIL ADDRESS:
TELEPHONE NUMBERS:
HOME ADDRESS:
RESEARCH ADVISOR:
ACADEMIC ADVISOR:
(HOME):
(WORK):
(CELL):
FIELD:
Annual Review Form / page 2
ACADEMIC AND RESEARCH ACTIVITIES:
Membership in Professional / Research Societies (e.g., APA, please
list all)
Number of authored / co-authored papers, posters, or workshops
presented in the past year?
Number of authored / co-authored papers, posters, or workshops
presented since you began graduate school at Loyola?
Number of authored / co-authored papers published in
professional journals and/or other scientific journals in the past
year?
Number of authored / co-authored papers published in
professional journals and/or other scientific journals since you
began graduate school at Loyola?
Number of authored / co-authored book chapters published in the
past year?
Number of authored / co-authored book chapters published since
you began graduate school at Loyola?
GOALS FOR NEXT YEAR:
What are your clinical goals for next year?
What are your research goals for next year?
Annual Review Form / page 3
What are your teaching goals for next year?
What are your professional development goals for next year?
COMMENTS ABOUT THE PAST YEAR:
What accomplishments should we acknowledge you for this year?
What problems or concerns have you had over the past year?
(Poor grades, probation, delay in proposing, etc.)
Annual Review Form / page 4
COURSEWORK
COURSE
NUMBER
COURSE NAME
Clinical Core Classes (all of the following courses are required)
412
Intro. To the Profession of Clinical Psychology
432
Intellectual & Personality Assessment
446
Psychopathology
Advanced Assessment course (Child Assessment 438 or
_________ Neuropsychological Assessment 553)
464
Practicum in Psychotherapy
464
Practicum in Psychotherapy
510
Ethics and Professional Practice
518
Human Diversity
518
Evidence-Based Practice in Clinical Psychology
------------- Advanced Therapy Course
Research & Methodology (all of the following courses are required)
401
History and Systems of Psychology
420
Research Methods in Psychology
482
Advanced Statistics
INSTRUCTOR
SEMESTER/
YEAR
GRADE
Annual Review Form / page 5
491
Multivariate Statistics
General Psychology Core (Area A; take one of the following):
421
Sensation and Perception
424
Learning and Memory
426
Physiological Psychology
435
Cognitive Neuroscience
552
Neuropsychology
General Psychology Core (Area B; ; take one of the following):
460
Social Psychological Theory
461
Attitude Organization & Change
462
Cognitive Social Psychology
474
Group Dynamics
General Psychology Core (Area C; ; take one of the following):
446
Psychopathology
455
Developmental Psychology
473
Social Development
475
Cognitive Development
APA Content Areas (APA 1): Biological Aspects of Behavior (take the following course)
552
Neuropsychology
APA Content Areas (APA 2): Cognitive Aspects of Behavior (take one of the following courses)
Annual Review Form / page 6
435
Cognitive Neuroscience
475
Cognitive Development
APA Content Areas (APA 3): Affective Aspects of Behavior (take the first two; 3rd is elective)
446
Psychopathology
552
Neuropsychology
473
Social Development
APA Content Areas (APA 4): Social Aspects of Behavior (take one of the following courses)
460
Social Psychological Theory
461
Attitude Organization & Change
462
Cognitive Social Psychology
474
Group Dynamics
APA Content Areas (APA 5): Psychological Measurement (take the following class)
432
Intellectual and Personality Assessment
APA Content Areas (APA 6): Individual Differences (take the first course; the other 2 are electives)
446
Psychopathology
473
Social Development
475
Cognitive Development
APA Content Areas (APA 7): Human Development (take the first two courses; the other 3 are electives)
446
Psychopathology
464
Practicum in Psychotherapy (x2)
Annual Review Form / page 7
451
Child Psychopathology
473
Social Development
475
Cognitive Development
Clinical-Child Track (course requirements for the track):
438
Child Assessment
451
Child Psychopathology
452
Child Psychotherapy
473
Social Development
475
Cognitive Development
Other Electives
436
Psychopharmacology
562
Cognitive Behavior Therapy
518
Family Systems Therapy
518
Health Psychology
518
Projective Assessment
518
Psychodynamic Psychotherapy
518
Child Law Class
545
Parenting
Annual Review Form / page 8
CLINICAL QUALIFYING EXAMINATION
Date Completed
Outcome
RESEARCH & ACADEMIC ACTIVITIES
Research Assistantships
Semester / Year
Supervisor
Hours / Week
Activities
Supervisor
Hours /
Week
Teaching Assistantships (TA)
Semester/ Year
Course Title
Activities
Annual Review Form / page 9
Teaching (Sole responsibility for course)
Semester / Year
Course Title
Departmental Presentations
Date
Nature of Presentation (e.g., brown bag) & Topic
Course #
Was This Part of a Teaching Fellowship?
Annual Review Form / page 10
FORMAL RESEARCH REQUIREMENTS
Master’s Thesis Title
Chair
Committee Members
Date Proposed
Date Defended
Dissertation Title
Chair
Committee Members
Date Proposed
Date Defended
OTHER RESEARCH ACTIVITIES
Semester/Year
Setting
Supervisor
Project Title/ Description
EXTERNSHIP /PRACTICUM EXPERIENCES
*see appic.org for a more detailed record form for keeping track of your practicum hours and experiences
Annual Review Form / page 11
Semester/
Year
Site
Type of
Setting
Name and
Degree of
Primary
Supervisor
Credentials
of Supervisor Types of
(i.e.,
Services
licensure,
Provided
ABPP)
Types of
Hours/
Clients Served Week
Clinical
Contact
Hours
(Total or
thus far)
NON-PRACTICUM CLINICAL EXPERIENCES
Semster/
Year
Site
Title
Activities
Name and
Degree of
Supervisor
Is Supervisor
Licensed?
(Yes / No)
Paid or
Unpaid?
Hours /
Week
Annual Review Form / page 12
INTERNSHIP
APA Accredited
(Yes or No)
Name and Location of Internship
Funded
(Yes or No)
Dates of Internship
FINANCIAL SUPPORT
Source of Current Financial Support (If Relevant)
Source of Financial Support For Next Year (If Relevant)
SUMMARY OF FINANCIAL SUPPORTS WHILE IN GRADUATE SCHOOL
Semester / Year
Source
Amount
AWARDS AND HONORS
(e.g., teaching fellowship, dissertation fellowship, APA minority fellowship, Kobler Award)
Annual Review Form / page 13
Date(s)
Award
Comments
PLEASE ALSO PROVIDE A COPY OF YOUR CURRENT CV TO THE DIRECTOR OF CLINICAL TRAINING AND TO YOUR ADVISOR
Annual Review Form / page 14
FACULTY/ADVISOR REVIEW OF STUDENT PROGRESS
Identifying INFORMATION
NAME:
TODAY’S DATE:
YEAR IN PROGRAM:
CLASSWORK
YES / NO
Any current incompletes on academic record?
Comments during Advisor/ Student meeting:
If yes, Identify:
Annual Review Form / page 15
Faculty evaluation:
Faculty comments during faculty review meeting:
Student Comments in response to faculty comments:
Unsatisfactory
Satisfactory
Annual Review Form / page 16
RESEARCH PROGRESS
Papers in Progress?
Comments during Advisor/Student Review:
Annual Review Form / page 17
Faculty evaluation:
Faculty comments during faculty review:
Student comments in response to faculty comments:
Unsatisfactory
Satisfactory
Annual Review Form / page 18
CLINICAL WORK
Has student given primary supervisor a copy of our
Practicum Evaluation form and asked for an
evaluation to be sent to the DCT?
Is there a supervisor’s evaluation of student
performance on PREVIOUS externships in student’s
file?
Has student completed an evaluation form for each
of his/her practicum sites?
Comments during Advisor/Student meeting:
YES / NO
YES / NO
YES / NO
Annual Review Form / page 19
Faculty evaluation:
Faculty Comments during faculty review:
Student Comments in response to faculty comments:
Unsatisfactory
Satisfactory
Annual Review Form / page 20
PROFESSIONAL DEVELOPMENT (E.G., PUNCTUALITY, FOLLOW-THROUGH ON RESPONSIBILITIES, RESPONSIVENESS TO
FEEDBACK, ETHICAL BEHAVIOR)
Comments during Advisor/Student Meeting:
Faculty evaluation:
Faculty Comments during faculty review:
Unsatisfactory
Satisfactory
Annual Review Form / page 21
Student Comments in response to faculty comments:
OTHER ACTIVITIES (E.G., ATTENDANCE AT COLLOQUIA, STUDENT MEETINGS, STUDENT COMMUNITIES, ETC.)
Comments during Advisor/Student Meeting:
Annual Review Form / page 22
Faculty evaluation:
Faculty Comments during faculty review:
Student Comments in response to faculty comments:
Unsatisfactory
Satisfactory
Annual Review Form / page 23
SUMMARY
Comments during Advisor/Student Meeting:
Overall Faculty Evaluation of Student Performance:
Faculty Comments during Faculty Review:
Unsatisfactory
Satisfactory
Annual Review Form / page 24
Student Comments in response to faculty comments:
Advisor’s Signature
Date
Student Signature
Date