HUMAN SERVICES Program
Educational Leadership and Counseling
Old Dominion University
SITE ADJUNCT INSTRUCTOR'S
MIDTERM EVALUATION OF STUDENT INTERN
Student Intern_____________________________________________
Agency/Organization________________________________________
Period Covered by Evaluation_________________________________
Site Adjunct Instructor________________________________________
Please use the following numbers to represent the various levels of achievement or competence:
0 - Not applicable
1 - Did not meet minimum performance expectations
2 - Met minimum performance expectations
3 - Met average performance expectations
4 - Met performance expectations to an above average degree
5 - Outstanding competence or accomplishment
- PROFESSIONAL BEHAVIORS WITH SAI
The intern:
1. Initiated regular concerns with SAI concerning internship experiences.
0 1 2 3 4 5
2. Turned in assignments to the SAI on time
0 1 2 3 4 5
3. Attendance and participation at SAI meetings
0 1 2 3 4 5
4. Was reliable, punctual, responsible and can follow directions when asked.
0 1 2 3 4 5
5. Was prepared for meetings.
0 1 2 3 4 5
- B. HUMAN RELATIONS SKILLS
The intern:
1. Exhibited a congruence between what he/she said and what he/she did when dealing with SAI
0 1 2 3 4 5
2. Conveyed ideas and thoughts clearly and articulately.
0 1 2 3 4 5
3. Admitted mistakes and accept responsibility for mistakes
0 1 2 3 4 5
4. Adapted well to new and unexpected situations (flexibility).
0 1 2 3 4 5
5. Displayed tact in expressing his/her views and in eliciting information.
0 1 2 3 4 5
6. Was able to resolve interpersonal difficulties with the SAI, other students and on-site staff.
0 1 2 3 4 5
7. Demonstrated ability to listen and attend to what others are saying.
0 1 2 3 4 5
8. Exhibited the ability to handle confidential information appropriately.
0 1 2 3 4 5
9. Demonstrated ability to communicate via writing (reports, letters, etc.).
0 1 2 3 4 5
- CONCEPTUALIZATION SKILLS:
(Impressions based on observations of the communication skills demonstrated by the intern's communications with SAI).
The intern could:
1. Articulate his/her personal theory of helping.
0 1 2 3 4 5
2. Conceptualize client problems in terms of a consistent sound, personal theory.
0 1 2 3 4 5
3. Identify the need for a specific technique.
0 1 2 3 4 5
4. Demonstrates openness to information and experiences, which appear contrary to his/her personal theory.
0 1 2 3 4 5
Intern's Signature/Date__________________________________________________
Site Adjunct Instructor's Signature/Date______________________________________
