Evaluation of Faculty Supervisor Form

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Term_________ Supervisor____________________________

Use the rating scale:

1=Poor

2=fair

3=Average

4=Very Good

5=Excellent

 

A. General Characteristics of the Supervisor
The Supervisor:
1. was available for discussion, questions, etc.	5 4 3 2 1
2. kept sufficiently informed of cases	5 4 3 2 1
3. allotted sufficient time for supervision	5 4 3 2 1
4. was interested in and committed to individual supervision	5 4 3 2 1
5. set clear objectives and responsibilities for supervision	5 4 3 2 1
6. presented a positive role model	5 4 3 2 1
7. provided direct observation with clients (live/audio/video)	5 4 3 2 1
8. provided regular feedback on performance	5 4 3 2 1
9. encouraged appropriate independence	5 4 3 2 1
10. demonstrated concern and interest in my progress, problems, ideas	5 4 3 2 1
11. maintained reasonable expectations	5 4 3 2 1
12. maintained appropriate interpersonal distance	5 4 3 2 1

13. Comments: 

B. Development of Counseling Skills
The Supervisor:
1. assisted student in coherent conceptualization of cases	5 4 3 2 1
2. assisted student in translation of conceptualization into specific techniques or procedures	5 4 3 2 1
3. was effective in providing suggestions for specific techniques.	5 4 3 2 1
4. was effective in helping to develop both short and long term goals for clients	5 4 3 2 1
5. was effective in facilitating student in other relationships with other professionals at the site	5 4 3 2 1
6. was sensitive to ethical concerns	5 4 3 2 1

Comments:

C. Summary

1. Describe something that your supervisor did which contributed significantly to your learning during this experience.

2. Describe specific changes you would suggest this supervisor incorporate to improve student learning future supervision experiences.