Trainee Evaluation Form 2011-2012 - Sfsu Department Of Counseling Field Work
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2SFSU Department of Counseling Field Work Trainee Evaluation Form 2014-2015
Student’s Name___________________________________________Signature_____________________________________
Supervisor’s Name/Title_________________________________________Signature______________________________
Agency/School___________________________________________________ No. of Fieldwork Hours_______________
Faculty Liaison________________________________________ Course Instructor: _______________________________
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Semester/Course:
Fall (706)
Spr(736)
Fall (890)
Spr (891)
Fall/Spr (850)
Sum (850)
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Degree Objective (check one):
M.S. MFCC (MFT)
M.S. Rehabilitation
M.S. Counseling
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Specialization:
Career
College
Gerontology
School
Rehab
MFT
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Emphasis:
Career
College
Gerontology
School
Rehab/Deafness
MFT
Date of Evaluation___________________________________________
Student Behaviors
Frequency of Behavior Displayed
Almost
Usually
Somewhat
Seldom
Almost
Not
always
never
applicable
1.
Attendance: is regularly
punctual
2.
Meets deadlines
3.
Responsible/dependable
4.
Cooperative/considerate
5.
Relates well to others
6.
Empathic to client’s
needs/feelings
7.
Shows ethnic/ cultural/
disability sensitivity
8.
Knows ethical/legal
principles
9.
Uses Knowledge
Appropriately
10. Open to
supervision/feedback
11. Flexible
12. Tolerant of imperfection
13. Self-aware
14. Appropriately self-
assertive
15. Willing to take risks
16. Shows potential for
growth/change
17. Demonstrates appropriate
behaviors overall
On Tally Response Form
A
B
C
D
E
F
(Bubble form), fill in =
Comment on student’s behavior and counseling skills (use back of form or attach additional sheets if needed).
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SFSU Department of Counseling Field Work Evaluation Form 2011-2012
Revised 1/30/2012
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