UNIVERSITY OF NORTHERN IOWA

SCHOOL PSYCHOLOGY PROGRAM

Intern Evaluation

Student ________________________ Site ______________________ Semester/Year _______

Site Supervisor_______________________ University Supervisor _______________________

The ratings provided on this form are intended to guide the student and the School Psychology program in evaluating the student’s readiness for supervised practice following the internship. Please use the following rating scale in evaluating the student on each of the dimensions below.

Send the completed form and direct any questions regarding practicum students to the University Supervisor. Thank you for providing supervision to the student and assisting in the professional development of school psychologists.

School Psychology Internship Supervisor

617 Schindler Education Center

Educational Psychology & Foundations

University of Northern Iowa

Cedar Falls, Iowa 50614

Rating Scale:

N/A Not applicable. Student was not observed practicing this skill, and it may not be appropriate for practice in this setting.

1 Unsatisfactory. Student’s performance reflects lack of critical knowledge and skill. Consultation with university supervisor is recommended.

2 Needs improvement. Student’s skills are developing in this area. Plans should be made to assure student has continued supervised practiced in this area.

3 Competent. Student’s skills in this area reflect sufficient mastery for independent practice in this setting with appropriate supervision. Satisfactory quality of work.

4 High Competent. Student’s skills in this area are very well developed and performed at an above average level. Student practices independently with minimal supervision.

5 Exceptional. Student demonstrates an unusually complete mastery of skill for a student at the internship level.

N/A-Not Applicable 1-Unsatisfactory 2-Needs Improvement 3-Competent 4-High Competent 5- Exceptional

Professional Behaviors

Presents a professional appearance. N/A 1 2 3 4 5

Is punctual for appointments and meetings. N/A 1 2 3 4 5

Aptly prepared and organized for meetings, reports, and appointments. N/A 1 2 3 4 5

Follows through with tasks and responsibilities in a prompt, N/A 1 2 3 4 5

well-organized manner.

Manages time realistically and efficiently. N/A 1 2 3 4 5

Completes written reports and forms in a neat, thorough, accurate N/A 1 2 3 4 5

manner.

Works with school staff in a professional manner. N/A 1 2 3 4 5

Displays initiative and resourcefulness. N/A 1 2 3 4 5

Data-Based Decision-Making and Accountability

Translates assessment results into empirically-based decisions about N/A 1 2 3 4 5

service delivery.

Moves logically from the conclusions reached as a result of an N/A 1 2 3 4 5

evaluation to the choice of intervention(s).

Clearly identifies the nature of the referral problem and the purpose of N/A 1 2 3 4 5

the assessment.

Uses appropriate assessment procedures and is sensitive to sources of N/A 1 2 3 4 5

bias when selecting, administering, and interpreting tests.

Appropriately administers and scores tests. N/A 1 2 3 4 5

Analyzes and interprets test results in a meaningful and thorough fashion. N/A 1 2 3 4 5

Presents assessment information to parents and teachers in an N/A 1 2 3 4 5

understandable and concise manner.

Considers all alternatives and implications before making N/A 1 2 3 4 5

recommendations for a child’s entitlement to special education.

N/A-Not Applicable 1-Unsatisfactory 2-Needs Improvement 3-Competent 4-High Competent 5- Exceptional

Integrates assessment information into a useful and readable report. N/A 1 2 3 4 5

Consultation and Collaboration

Collaborates effectively with others in planning and decision-making. N/A 1 2 3 4 5

Communicates and listens effectively. N/A 1 2 3 4 5

Is tolerant of others’ values and viewpoints. N/A 1 2 3 4 5

Is assertive in problem-solving when needed. N/A 1 2 3 4 5

Shows concern, respect, and sensitivity for others. N/A 1 2 3 4 5

Effectively involves teachers and other school staff in collaborative N/A 1 2 3 4 5

consultative relationships.

Evaluates effectiveness of consultation strategies used. N/A 1 2 3 4 5

Effective Instruction and Development of Cognitive/Academic Skills

Demonstrates knowledge of learning processes and techniques to assess N/A 1 2 3 4 5

these processes.

Develops appropriate cognitive and academic goals for students. N/A 1 2 3 4 5

Implements interventions to achieve identified cognitive and N/A 1 2 3 4 5

academic goals.

Evaluates effectiveness of interventions addressing cognitive and N/A 1 2 3 4 5

academic goals.

Demonstrates knowledge of effective teaching methods. N/A 1 2 3 4 5

Develops interventions that utilize the strengths of the child. N/A 1 2 3 4 5

Socialization and Development of Life Skills

Demonstrates knowledge of human developmental processes and N/A 1 2 3 4 5

techniques to assess these processes.

N/A-Not Applicable 1-Unsatisfactory 2-Needs Improvement 3-Competent 4-High Competent 5- Exceptional

Develops appropriate behavioral, affective, adaptive and social goals N/A 1 2 3 4 5

for students.

Implements interventions to achieve identified behavioral, affective, N/A 1 2 3 4 5

adaptive and social goals.

Demonstrates knowledge of classroom management procedures. N/A 1 2 3 4 5

Evaluates effectiveness of interventions addressing goals which may N/A 1 2 3 4 5

include consultation, behavioral intervention, and counseling.

Develops interventions that utilize the strengths of the child. N/A 1 2 3 4 5

Student Diversity in Development and Learning

Demonstrates knowledge of individual differences, abilities, and N/A 1 2 3 4 5

disabilities.

Demonstrates knowledge of the potential influence of biological, social, N/A 1 2 3 4 5

cultural, ethnic, socioeconomic, gender-related and linguistic factors.

Demonstrates sensitivity and skills needed to work with diverse N/A 1 2 3 4 5

Individuals.

Implements strategies selected and/or adapted based on individual N/A 1 2 3 4 5

characteristics, strengths, and needs.

Achieves comfortable interactions with students of other ethnic and N/A 1 2 3 4 5

cultural backgrounds.

School and Systems Organization, Policy Development, and Climate

Demonstrates knowledge of general education, special education, and N/A 1 2 3 4 5

other educational and related services.

Understands schools and other settings as systems. N/A 1 2 3 4 5

Works with others to create and maintain a safe, supportive, and N/A 1 2 3 4 5

effective learning environment.

N/A-Not Applicable 1-Unsatisfactory 2-Needs Improvement 3-Competent 4-High Competent 5- Exceptional

Prevention, Crisis Intervention, and Mental Health

Demonstrates knowledge of how human development and N/A 1 2 3 4 5

psychopathology influence human behavior.

Contributes to prevention and intervention programs the promote mental N/A 1 2 3 4 5

health and physical well-being.

Home/School/Community Collaboration

Demonstrates knowledge of family systems and how families influence N/A 1 2 3 4 5

student development, learning, and behavior.

Involves families in education and service delivery. N/A 1 2 3 4 5

Works effectively with families, educators, and community members. N/A 1 2 3 4 5

Plans and implements effective parent/community education programs. N/A 1 2 3 4 5

Demonstrates an awareness of community agencies and programs. N/A 1 2 3 4 5

Research and Program Evaluation

Monitors the integrity of intervention implementation. N/A 1 2 3 4 5

Consults appropriate literature when gathering information, planning N/A 1 2 3 4 5

assessments and interventions, and making recommendations.

School Psychology Practice and Development

Practices according to ethical, professional and legal standards. N/A 1 2 3 4 5

Demonstrates an awareness of competency level and doesn’t accept N/A 1 2 3 4 5

responsibilities beyond this level.

Utilizes constructive criticism. N/A 1 2 3 4 5

Shows evidence of continued self-evaluation. N/A 1 2 3 4 5

Keeps supervisor informed of unusual events and activities, as well N/A 1 2 3 4 5

as routine matters.

N/A-Not Applicable 1-Unsatisfactory 2-Needs Improvement 3-Competent 4-High Competent 5- Exceptional

When necessary, able to work independently without supervision. N/A 1 2 3 4 5

Information Technology

Accesses, evaluates, and utilizes information sources and technology in N/A 1 2 3 4 5

ways that safeguard or enhance quality of services.

Please comment concerning the student’s strengths and weaknesses, with particular attention to their training and level of expertise.

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Signature of On-site Supervisor date

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Signature of University Supervisor date

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Signature of Student* date

*Indicates that the evaluation has been discussed with the student