Fillable Practicum Evaluation Site Supervisor Please provide comments on (Wisconsin Lutheran College)

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Practicum Evaluation Site Supervisor Please provide comments on (Wisconsin Lutheran College)

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Practicum Evaluation
Site Supervisor
Student's Name ___________________________________________________________
Agency _________________________________________________________________
Job Title Supervisor's Name _________________________________________________
Please provide comments on the following items related to the student's activities in your agency.
Please comment in the space provided on this form or attach additional pages as needed. It will
be helpful to the student if both strengths and weaknesses are covered in your observations.
Please discuss this with the student.
1. Learning Experiences. What tasks did the student perform in your agency? Please include
learning contract activities and accomplishments in your description.
If there are learning contract activities which have not been performed, please provide an
explanation and/or arrangements for including these activities for next semester.
2. Development of Knowledge and Skills: Describe student's ability to use personality,
knowledge, and helping skills with individuals, groups and/or neighborhoods.
3. Agency Awareness: Comment on student's understanding of agency goals, policies, and
procedures, ability to make appropriate decisions and relationships with agency staff.
Describe how student makes appropriate use of agency and community resources.
4. Life/Work Planning. Describe areas in which student needs additional skill and/or knowledge
development.
What suggestions do you have for further growth?
Would you recommend student be employed in your agency? What additional skills
would s/he need?
_________________________________________________________________________
Signature of Student Date
_________________________________________________________________________
Signature of Supervisor Date
Practicum Evaluation
Student name ____________________________________________________________
Date ___________________________________________________________________
Agency _________________________________________________________________
Practicum Supervisor ________________________________________________________
Please evaluate the student on each of the listed dimensions using the rating scale below. Give
only one rating for each dimension. Written comments are encouraged and are very useful to the
student and the Practicum Instructor.
1 = Outstanding 2 = Above Average 3 = Average
4 = Below Average 5 = Unsatisfactory NA = Does Not Apply
Once you complete the evaluation, you are encouraged to go over it with the student.
I. Professionalism
a) Adheres to ethics/confidentiality 1 2 3 4 5 NA
b) Punctuality and time management 1 2 3 4 5 NA
c) Adheres to Agency policies 1 2 3 4 5
NA
d) Record keeping 1 2 3 4 5 NA
e) Relations with staff 1 2 3 4 5 NA
f) Participating in staff meetings 1 2 3 4 5 NA
g) Dress and appearance 1 2 3 4 5 NA
h) Emotional maturity 1 2 3 4 5 NA
I) ability to maintain boundaries 1 2 3 4 5 NA
J) Overall professionalism 1 2 3 4 5 NA
Comments:
1 = Outstanding 2 = Above Average 3 = Average
4 = Below Average 5 = Unsatisfactory NA = Does Not Apply
II. Job Performance
a) openness for critical comments 1 2 3 4 5 NA
b) positive, non-judgmental attitude 1 2 3 4 5 NA
c) effective use of suggestions 1 2 3 4 5 NA
d) verbal communication skills 1 2 3 4 5 NA
e) written communication skills 1 2 3 4 5 NA
f) problem solving skills 1 2 3 4 5 NA
g) independent learning 1 2 3 4 5 NA
h) concern for clients 1 2 3 4 5 NA
i) conceptual skills 1 2 3 4 5 NA
j) applies new information appropriately 1 2 3 4 5 NA
k) overall job performance 1 2 3 4 5 NA
Comments:
III. Overall Evaluation: Please discuss the student’s strengths, areas in need of improvement,
interpersonal skills, knowledge base and ability to apply knowledge in practical settings.
IV. If you were grading this person, what would you recommend based on the student’s overall
work performance?
A AB B BC C CD D F
Practicum Supervisor’s signature _________________________________________________
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Completed 21 July 2020

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