Evaluation of student by supervisor

Student Evaluation of Practicum or Summer Clerkship

Please submit to Co-ordinator of Practica and Summer Clerkships within 2 weeks of the end of the placement.

Part 1:  Self Evaluation

 Please report in numbered order

  1. Student's name
  2. Practicum agency and starting and ending dates
  3. Name of agency practicum co-ordinator
  4. List of other supervisors
  5. Summary of your own experience and supervision, based on AAPI form* for applying to internships.  Include information on non-direct-service experience such as consultation, ward rounds, group therapy, observation.
  6. Summary of your own relevant strengths and weaknesses and progress toward your learning goals
  7. What would you do differently if you were to repeat this placement?
  8. Date, student's signature, primary supervisor's signature

*AAPI = "APPIC Application for Psychology Internship", Association of Psychology Postdoctoral and Internship Centers, available from www.appic.org


Part 2:  Evaluation of Setting and Supervision

Please report in numbered order

    1. Student's name
    2. Practicum agency and starting and ending dates
    3. Name of agency practicum co-ordinator
    4. List of other supervisors
    5. Comments on the practicum setting: availability of learning opportunities, appropriateness of experience, office facilities, audiovisual and computer equipment, clerical support, interactions with other staff
    6. For each supervisor separately, comments on any or all of the following aspects of supervision, or others.  To what extent was the supervisor:
      1. accessible
      2. approachable
      3. open to feedback
      4. respectful - empathic
      5. supportive
      6. knowledgeable
      7. flexible
      8. clear in expectations
      9. prompt with feedback
    7. Date, student's signature, primary supervisor's signature

Policy on Evaluation of Student Competence in the Clinical Psychology Program

Professional psychologists are expected to demonstrate competence within and across a number of different but interrelated dimensions. Programs that educate and train professional psychologists also strive to protect the public and profession. Therefore, faculty, supervisors and administrators in such programs have a duty and responsibility to evaluate the competence of students across multiple aspects of performance, development and functioning.

Students in professional psychology programs (at the doctoral, internship, or postdoctoral level) should know that faculty, supervisors and administrators have a professional, ethical and potentially legal obligation to evaluate their competence in areas other than, and in addition to, coursework, seminars, scholarship, comprehensive examinations, clerkships, practica or related program requirements. Within a developmental proactive framework, and with due regard for the inherent power difference between students and faculty, these evaluative areas include, but are not limited to, demonstration of sufficient:

  1. Interpersonal and professional competence (e.g., the ways in which student-trainees relate to clients/patients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories);
  2. Self-awareness, self-reflection, and self-evaluation (e.g., knowledge of the content and potential impact of one's own beliefs and values on patients/clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories);
  3. Openness to processes of supervision (e.g., the ability and willingness to explore issues that either interfere with the appropriate provision of care or impede professional development or functioning); and
  4. Resolution of issues or problems that interfere with professional development or functioning in a satisfactory manner (e.g., by responding constructively to feedback from supervisors or program faculty; by the successful completion of remediation plans; by participating in personal therapy in order to resolve issues or problems).


Actions based on this policy will be considered when a student's conduct clearly and demonstrably

  1. Impacts the performance, development, or functioning of the student,
  2. Raises questions of an ethical nature,
  3. Represents a risk to public safety,
  4. Damages the representation of psychology to the profession or public.

Core Clinical Psychology faculty may review such conduct within the context of the program's evaluation processes.


Related policies:


Below lists all the forms available from the Department of Psychology.

Forms in the Rich Text format (RTF) allow you to fill in the necessary information using Microsoft Word or WordPerfect before printing the form out. Forms in the Adobe Acrobat(PDF) format are also available but cannot be filled out before printing. You must have Adobe Acrobat Reader installed to view these forms.

For current graduate students 

Approval of Thesis/Dissertation Proposal : doc  pdf   
Student/Supervisor Agreement Template: pdf

For graduate students in Clinical Psychology

APPIC Verification Form for Application for Clinical Psychology Internship 
Clinical Practicum and Summer Intership Evaluation Form
Evaluation Form for Clinical Case Presentations for Comprehensive Exams