Graduate Student Extern Evaluation Form printable pdf download

GRADUATE STUDENT EXTERN EVALUATION FORM

Student:__________________________ Date of evaluation:____________________

Site:_____________________________ Supervisor:__________________________

□ First full-time internship

□ Second full-time internship

Check one:

□ Midterm evaluation

□ Final evaluation

Caseload includes (check all that apply):

Age groups:

□ Early childhood (birth-grade 2)

□ Childhood (grades 1-6)

□Middle Childhood (grades 5-9)

□ 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)

Skill Not

Emerging

Adequate

Strong

Apparent

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-2-

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-G-

2-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)

Graduate Student Extern Evaluation Form

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