Intern: ___________________________________ Evaluation Date: Mid _______ Final _______
Supervisor: ____________________________________ Site: __________________________________
Please check all that apply:
□ State Dep. of Ed. License/Certification (school psychologist)
□ NCSP □ State DORA License (licensed psychologist)
Please use the following ratings to evaluate the intern at midterm and at the end of the intern’s placement.
If the intern has not yet had the opportunity to attempt a particular skill, please note NA and note in the comment section a plan for how the intern will address that competency. It is expected that by the end of the internship experience, the intern will reach level 4/5 in all areas.
In rare cases, an intern may not have an opportunity to demonstrate a competency (e.g., respond to a crisis, # 31). In those instances, the intern and his/her supervisor should note the types of activities that have been substituted to approximate this skill (e.g., knowledge of crisis plan, attendance at workshop).
1 – Requires supervision for all aspects of task; heavy emphasis on skill acquisition – Novice
2 – Requires supervision for all aspects of task; from initiation to completion – Advanced Beginner
3 – Requires supervision initiating task and evaluating task completion; completes task independently –
Competent
4 – Requires supervision on final aspect (evaluation) of task completion, but initiates and carries out tasks on own – Proficient
5 – Independent on all aspects of task completion, including initiation and evaluation – Independent
Goal 1 : School psychology interns will have a broad and general understanding of the theoretical and conceptual foundations of psychology.
Competencies
Integrate theoretical knowledge and research to address underlying developmental, biological, cognitive, affective, and social bases of behavior.
Apply understanding of these bases of behavior to improve social, emotional, behavioral, and educational outcomes for all children/students.
Measure these bases of behavior from infancy to adulthood.
Use knowledge about learning and cognition to facilitate academic growth in students
Adapt psychological practices to developmentally appropriate levels that meet the needs of the individual.
Comments:
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
Goal 2 : School psychology interns are able to implement systemic and consultative interventions
Competencies
Communicate effectively with school personnel, families, and students. 1 2 3 4 5 NA

Display good listening skills.
Know and be able to implement effective evidence-based service models, as related to universal, selective, and targeted intervention.
Convey knowledge of various systems (e.g., family, school, community) and the complexities of systems-level interactions both within and across these settings.
Work to create/strengthen ties to the community and its resources.
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
Exhibit knowledge of family systems, including family strengths and influences on student development, learning and behavior.
Promotes family involvement through frequent communication, consultation, and/or parent training activities.
Select and implement the most appropriate consultative model for each system.
Evaluate the effectiveness of consultation and modify as appropriate.
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA Adapt practice in consideration of the impact of diversity in social and cultural backgrounds and linguistic differences, when working with families, school personnel and community agencies.
Implement effective systemic prevention or intervention programming.
In collaboration with others, develop appropriate educational goals for students with different abilities, disabilities, strengths, and needs.
Conducts effective in-services or other programs for parents, school staff members, or others
1 2 3 4 5 NA
1 2 3 4 5 NA
Participate in the development and implementation of policies and practices that create effective learning environments.
Participate in risk assessments and crisis response planning
1 2 3 4 5 NA
1 2 3 4 5 NA
Respond effectively to crisis situations.
1 2 3 4 5 NA
1 2 3 4 5 NA
Comments:
Goal 3 : School psychology interns are knowledgeable and skilled in comprehensive assessment for the purpose of understanding challenges, developing interventions, and measuring change.
Select evaluation methods that are most appropriate. 1 2 3 4 5 NA
1 2 3 4 5 NA Accurately administer, score, interpret, and report (in both written and oral format) various cognitive, personality, academic, and behavioral measures.
Implement a systematic process for data collection that includes more informal methods such as interviews and observations; behavioral, curriculum-based, and play-based assessment; and ecological or environmental evaluations.
Translate assessment results into empirically based decisions about service delivery.
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA Develop academic and social/behavioral interventions, through direct or indirect services, that reflect knowledge and understanding of a student’s culture, language, and individual learning characteristics.
Facilitate the implementation of individualized interventions to achieve student goals.
Identify risk and resiliency factors in children and use this information in program development.
Evaluate the effectiveness of interventions and modify as necessary and appropriate.
Participate in school-wide program evaluation efforts
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
Comments
Goal 4 : School psychology interns are able to skillfully provide psychological services.
Competencies

Demonstrate knowledge and skill in identifying individuals or groups who may benefit from intervention services.
Recognize psychopathology and articulate its potential influence on school functioning.
Select and implement evidence-based direct services (e.g.. individual and group counseling).
Monitor and document progress (and modify services as necessary).
Comments
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
Goal 5 : School psychology interns are prepared to engage in culturally competent legal, ethical, and professional practice.
Competencies
Adhere to legal and ethical standards as applied to psychological research and practice.
Recognize and understand the factors that contribute to individual differences, including ability, culture, SES, sexual orientation, and language.
1 2 3 4 5 NA
1 2 3 4 5 NA
Convey the sensitivity and skills necessary to work with diverse types of individuals and families
Integrate principles of advocacy and social justice into service delivery.
Exhibit skill in culturally responsive practice (e.g., consultation, assessment, intervention) that reflects adherence to legal and ethical standards.
Demonstrate commitment to ongoing professional preparation and leadership.
Understand the history and foundations of school psychology.
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
Comments
Goal 6: School psychology interns are competent in understanding, using, and conducting research.
Display skill in evaluating and applying current research in the field of school psychology.
Apply knowledge of research design, methodology, and statistical analysis.
Comments
1 2 3 4 5 NA
1 2 3 4 5 NA
Professional Work Characteristics
Communication skills
Adaptability
Effective interpersonal relations
Initiative and dependability
Ethical responsibility
Respect for human diversity
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
1 2 3 4 5 NA
Comments
Midterm Goals:
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Ongoing Professional Development Goals: (to be completed at final evaluation)
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Intern Signature and Date
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Field Supervisor(s) Signature and Date
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University Supervisor Signature and Date