ࡱ> `b_` +bjbj 2J`h+h+h+8+$+!7\,l,:,,,,,,6666666$18h:068.,,8.8.6,,63338.,,638.6333,P, `m#h+2/f3\3D60!73:0 :3:3L,L,63(-,T-,,,662X,,,!78.8.8.8.$D)$D)  SEQ CHAPTER \h \r 1 UNIVERSITY OF CENTRAL ARKANSAS DEPARTMENT OF PSYCHOLOGY AND COUNSELING EVALUATION OF PSYCHOLOGY INTERNSHIP SITE Intern ________________________________ Supervisor ______________________ Agency _____________________________________ Department _________________ Date of Internship: From __________________ To ___________________ mth/day/yr mth/day/yr Type of Internship: Counseling Psyc Community Coun In order to help the Psychology and Counseling Internship Committee evaluate the adequacy of agencies for internship sites, please rate your internship experience on the items below. These ratings will be helpful to future interns in selecting internship sites. To ensure confidentiality, this first page will only be seen by the Internship Committee if there is a concern. The remaining evaluation pages will be available to students but without identification. Instructions Under Opportunity, rate the extent to which you had the opportunity to engage in the activity. 1 2 3 4 NA None Little Some Much Not Applicable Under Supervision, rate the adequacy of feedback and supervision. Supervision does not necessarily need to be from your primary supervisor. 1 2 3 4 NA None Little Some Much Not Applicable EVALUATION OF INTERNSHIP SITE Agency _______________________________ Department _____________________ Address ______________________________ Dates __________________________ EXPERIENCES Opportunity Supervision A. Populations 1. children 1 2 3 4 NA 1 2 3 4 NA 2. adolescents 1 2 3 4 NA 1 2 3 4 NA 3. adults 1 2 3 4 NA 1 2 3 4 NA 4. elderly 1 2 3 4 NA 1 2 3 4 NA Please list type of populations seen and approximate percent of time that you worked with each (ex: depressed 25%, substance abuse 10%, schiz 10%, etc) B. Testing 1. Administer objective 1 2 3 4 NA 1 2 3 4 NA personality tests. 2. Interpret objective 1 2 3 4 NA 1 2 3 4 NA personality tests. 3. Administer projective 1 2 3 4 NA 1 2 3 4 NA personality tests. 4. Interpret projective 1 2 3 4 NA 1 2 3 4 NA personality tests. 5. Administer individual 1 2 3 4 NA 1 2 3 4 NA Intellectual tests. 6. Interpret individual 1 2 3 4 NA 1 2 3 4 NA tests. 7. Administer psychoeduc Tests 1 2 3 4 NA 1 2 3 4 NA 8. Interpret psychoeduc Tests 1 2 3 4 NA 1 2 3 4 NA 9. Psychological report Writing 1 2 3 4 NA 1 2 3 4 NA 10. Other testing opportunity _______________________________________________________________ Counseling 1. Conduct intake interviews 1 2 3 4 NA 1 2 3 4 NA 2. Conduct individual counseling. 1 2 3 4 NA 1 2 3 4 NA 3. Conduct group counseling as 1 2 3 4 NA 1 2 3 4 NA facilitator or co-facilitator. 4. Conduct marriage/ family couns. 1 2 3 4 NA 1 2 3 4 NA 5. Crisis intervention. 1 2 3 4 NA 1 2 3 4 NA 6. Other _________________________________________________________________________________ Overall Rating 1. How did the experience and training received compare to what you expected or to what was promised? 1 2 3 4 5Very disappointingLess than expectedMet expectationsMore than expectedWell exceeded expectations 2. Overall quality of supervision. 1 2 3 4 5 poor  fair acceptable good excellent  3. Professional atmosphere and cooperation among staff. 1 2 3 4 5 poor  fair acceptable good excellent  4. To what extent were you treated respectfully by your supervisor? 1 2 3 4 5Very disappointingLess than expectedMet expectationsMore than expectedWell exceeded expectations 5. To what extent were you treated respectfully by other staff? 1 2 3 4 5Very disappointingLess than expectedMet expectationsMore than expectedWell exceeded expectations 6. All things considered, what is your recommendation of this site to others? 1 2 3 4 5 poor  fair acceptable good excellent  7. What are the best things about this site? 8. What things do you feel need to be changed in order to improve the site? Stipend Were you paid? ______ If so, how much ___________ per ___________ y/n amount hr,wk, or mth Comments Please make any additional comments that you feel will be helpful.     PAGE 2 PAGE 1 Friday, October 14, 2005  FILENAME Int_eval_student   5 8 45;_(X 8⽲hCJOJQJhp^CJOJQJh:JCJOJQJhp^5CJOJQJh:J5CJOJQJhM8OJQJhM85OJQJh5OJQJh:J5OJQJh:JOJQJh:Jjh:JU:6_`! 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