Evaluation of Site Supervisor

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Evaluation of Site Supervisor and Practicum Experience Student Name: Field/Practicum Location: Field/Practicum Supervisor Name: Semester: Please circle the number that best describes your experience of the practicum supervisor and the practicum setting. The recommendations and suggestions in the comments section below will provide ICSW with valuable information for future student placements.

1 Fails to Meet Expectations

2 Below Expectations

3 Meets Expectations

4 Above Expectations

5 Exceeds Expectations

I. Supervisory Relationship 1) My supervisor was available and accessible. ______ 2) My supervisor and I met for regular supervision. ______ 3) My supervisor utilized the learning contract to guide our work together._____ 4) My supervisor provided clear and consistent expectations.______ 5) My supervisor encouraged my professional development. ______ 6) My supervisor provided me the opportunity to strengthen my practice skills.______ 7) My supervisor encouraged me to explore ethical issues in my work. ______ 8) My supervisor solicited my thoughts and opinions related to my practicum work. ______ 9) My supervisor was knowledgeable and/or open to a psychodynamic clinical framework._____ 10) My supervisor assigned me work that was meaningful and challenging. ______ TOTAL SCORE: 1

COMMENTS:

II. The Practicum Setting 1) The site provided an orientation to help me understand my role in the practicum setting. _____ 2) The site provided information about the client population served. ______ 3) There was clarity in the setting about its program and methods.________ 4) The setting’s philosophy of service is compatible with values and ethics of the counseling profession._______ 5) There was adequate work space; for example, access to a telephone, supplies, and interviewing facilities._______ 6) The agency/staff are receptive to the students’ learning needs. _______ 7) The setting is non-discriminatory in employment of staff, placement of students, and the delivery of services._______ 8) The setting provides an atmosphere that is conducive to learning and one in which a student feels welcome. _______ 9) I would consider working at this site post-graduation. _______ 10) I would recommend this site to another ICSW student. _______ TOTAL SCORE: STRENGTHS AND WEAKNESSES OF SITE AND OTHER COMMENTS:

2