Cc: Student File
Course Instructor
Field Supervisor
University of Northern Colorado
School Psychology Practicum Evaluation Ph.D.
Student: ____________________________________ Date: _____________
Supervisor: _________________________________ Site: ____________________________________
Please check all that apply:
□ State Dep. of Ed. License/Certification (school psychologist)
□ NCSP
□ State DORA License (licensed psychologist)
Please complete and return this evaluation form to the practicum supervisor at the end of the trainee’s
practicum experience. Please rate according to the following scale, with N/A indicating that the practicum
student has not had an opportunity to attempt the task.
1—Requires supervision for all aspects of task, heavy emphasis on skill acquisition—Novice
2—Requires supervision for all aspects of task—Advanced Beginner
3—Requires supervision with some aspects of task completion, but completes task
independently—Competent
4—Requires supervision on final aspect (evaluation) of task completion, but initiates and carries
out tasks on own—Proficient
Goals/Competencies
Goal 1: Student demonstrated a broad and general understanding of the
theoretical and conceptual foundations of psychology.
Demonstrated knowledge of the theories and relevant research underlying the
biological, cognitive, affective, and social bases of behavior.
Applied understanding of these bases of behavior to improve social, emotional,
behavioral, and educational outcomes.
Demonstrated skill in measuring these bases of behavior with individuals of various
ages.
Demonstrated knowledge in the theories and relevant research underlying human
development.
Adapted psychological practices to developmentally appropriate levels to meet the
needs of the individual.
1
2
Rating
3 4 N/A
1
2
3 4 N/A
1
2
3 4
N/A
1
2
3 4
N/A
1
2
3 4 N/A
1
2
3 4
N/A
2
2
2
2
2
2
Rating
3 4
3 4
3 4
3 4
3 4
3 4
N/A
N/A
N/A
N/A
N/A
N/A
Comments
Goals/Competencies
Goal 2: Student was able to implement systemic and consultative interventions.
Demonstrated knowledge of various systems (e.g., family, school, community).
Exhibited knowledge of various consultative and collaborative approaches.
Skillfully developed rapport with others (e.g., clients, families, team members).
Displayed good communication skills
Successfully used consultation skills with various populations
1
1
1
1
1
1
Evaluated the effectiveness of consultative efforts as applied to families, schools, and
systems.
Implemented effective systemic prevention or intervention programming
Applied appropriate methods for responding to crises (e.g., suicide, threat)
Assisted clients (and their families) in connecting to community resources as
appropriate.
1
2
3 4
N/A
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
Comments
Goals/Competencies
Goal 3: Student provided comprehensive assessment of individuals, programs,
and systems for the purpose of understanding challenges, developing
interventions, and measuring progress.
Demonstrated knowledge and skill in administering and scoring assessments
Effectively conducted comprehensive interviews
Exhibited skill in case conceptualization and diagnosis based on assessment results
Prepared effective written reports
Provided appropriate feedback regarding assessment results to clients and/or their
families
Used assessment results to generate appropriate recommendations and/or intervention
plans
Demonstrated knowledge and skill in measuring intervention and/or program outcomes.
1
2
Rating
3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1
2
3 4 N/A
1
2
3 4
1
2
Rating
3 4 N/A
1
2
3 4 N/A
N/A
Comments
Goals/Competencies
Goal 4: Student was able to skillfully provide evidence-based psychological
services.
Demonstrated knowledge and skill in identifying individuals or groups who may benefit
from intervention services.
Selected appropriate, empirically validated intervention strategies.
Skillfully implemented appropriate intervention strategies
Used effective methods for monitoring and documenting progress.
Comments
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
Goals/Competencies
Goal 5: Student was prepared to engage in culturally competent legal, ethical,
and professional practice.
1
Adhered to legal and ethical standards as applied to psychological research and practice.
Demonstrated knowledge of federal, state, and local accountability procedures
Recognized and understood the factors that contribute to individual differences.
Exhibited skill in culturally responsive practice (e.g., consultation, assessment,
intervention)
Participated in continuing education opportunities offered through the site or as relevant
to externship practice.
2
Rating
3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1 2 3 4 N/A
1
2
3 4
N/A
1
Rating
2 3 4 N/A
1
2
3 4 N/A
1
2
3 4
Comments
Goals/Competencies
Goal 6: Student was competent in understanding, using, and conducting
research.
Accessed appropriate, quality research as appropriate for assessment and intervention
planning.
Participated in research opportunities as appropriate to the site.
Comments
Student demonstrated appropriate personal and professional behavior











Showed interest and enthusiasm for work
Accepted responsibility for own behavior
Willingly accepted and carried out assignments
Was punctual and had good attendance
Completed work efficiently with minimal oversight
Accepted and responded appropriately to supervision
Demonstrated effective time management
Displayed flexibility in planning according to the situation
Returned phone calls/emails promptly
Recognized own limitations and sought advice
Adhered to site policies and procedures
1. Areas of strength or competency:
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
N/A
2. Areas for growth or additional training.
I certify that I have read the evaluation.
______________________________________
Practicum Student’s Signature
________________
Date
______________________________________
Site Supervisor’s Signature
________________
Date
______________________________________
University Supervisor’s Signature
________________
Date
Reminder: Make a copy of this completed form with signatures for the student’s folder in the
Main Office.