Evaluation of Practicum Experience

Below is an online evaluation form for students to use to evaluate their clinical practicum and their intensive supervision experience. This is done every semester in which a student is enrolled in a clinical practicum course. All information is deidentified and your feedback including your written comments are ONLY provided to each supervisor in aggregate form at the end of your practicum training year.

Name of Student:

Date:

NSU Email:

NSU ID

Phone/Cell Phone:

What practicum course did you just complete?

Semester:

Year:

Agency/Program Name:

Site and Intensive Supervisor are one and the same:

Name of Intensive Supervisor:

Additional Supervision Provided by:

Starting date for current practicum year:

Month:

Year:

How many hours have you completed this semester?

Student Activities:
Fill in each box with the average number of hours per week at this site. If you have no hours, write "0."

Patient Contact

Testing:

Therapy:

Other:

Supervision of your work in

Testing:

Therapy:

Other:

Staffings:

Research:

Other:

Evaluations:

Rating of placement as a learning experience.

Rating of supervision received.

Did you feel adequately prepared for this placement?

If NO, what additional training would have been useful?

Comment on the positive aspects of this placement:

Please provide any feedback you feel would have enhanced your experience in this placement.

Practicum "Site" Supervision Evaluation

A Nova site has one person for both practicum and intensive supervision as opposed to an off site whereby you have a site supervisor and a Nova intensive supervisor.

Practicum Supervisor's Name:

* Please rate your Practicum Supervisor in each of the areas listed below:

Supervisor's knowledge of assessment/diagnostic issues, therapeutic techniques, and client populations.

Supervisor's knowledge of pertinent legal and ethical issues.

Supervisor's knowledge of relevant clinical and research literature.

Supervisor's knowledge of diversity issues and their impact on mental health.

Supervisor's ability to relate effectively to students (attitude, flexibility and openness, interest and enthusiasm and capacity to facilitate student exploration of relevant personal issues).

Clarity of objectives for supervision.

Clarity of expectations and evaluation criteria.

Overall rating of your Practicum Supervisor.

* Below, please indicate how much you strongly agree or disagree with the following statements:

I received the amount of supervision specified in my practicum contract.

My supervision time was rarely canceled, delayed, or shortened.

When my supervision time was canceled, delayed, or shortened, the supervision time was subsequently made up.

My supervisor infrequently allowed interruptions (e.g., phone calls). If interruptions occurred with regularity, please describe them in the comment section provided.

My written work was carefully reviewed and sufficient feedback was given.

My supervisor was open to a range of approaches to treating my cases.

A sufficient amount of supervision time was spent reviewing taped therapy materials.

Didactic presentations, when warranted, were incorporated into the supervision.

My supervisor remained abreast of my caseload and my clients' progress.

General Comments:

Intensive Supervision Evaluation

Not for supervisors of PSC faculty clinics or for off site clinical supervisors (e.g., VA, hospitals, UM/JMMC, etc). This is for intensive supervisors that supervise students who are at non Nova practicum sites.

Intensive Supervisor's Name:

Please rate your Intensive Supervisor in each of the areas listed below:

Supervisor's knowledge of assessment/diagnostic issues, therapeutic techniques, and client populations.

Supervisor's knowledge of pertinent legal and ethical issues.

Supervisor's knowledge of relevant clinical and research literature.

Supervisor's knowledge of diversity issues and their impact on mental health.

Supervisor's ability to relate effectively to students (attitude, flexibility and openness, interest and enthusiasm and capacity to facilitate student exploration of relevant personal issues).

Clarity of objectives for supervision.

Clarity of expectations and evaluation criteria.

Overall rating of your Intensive Supervisor.

Below, please indicate how much you strongly agree or disagree with the following statements:

I received an average of 45 minutes per week on my case(s).