1 School Psychology Internship Evaluation Psychology 686: Internship in School Psychology Millersville University Department of Psychology Intern: Field Supervisor: Date of Evaluation: / / School District: Instructions: This form is designed to help supervisors provide feedback about the performance of students during their field experience. It will become a part of the student s record and may be considered in assigning grades for the practicum course. Please answer each item using the scale provided. If you feel it would be helpful to provide a context in which to consider your ratings, please feel free to do so below. Answer Code for Evaluation Items: N/O = not observed 1 = does not meet proficiency 2 = partially proficient 3 = proficient 4 = exemplary I. Professional Dispositions (Behavior) A. Communicates Professionally 1. Follows appropriate channels of communication 2. Abides by FERPA (Federal Educational Rights and Privacy Act) 3. Writes and speaks to easily understood by multiple audiences 4. Conveys professional tone 5. Listen carefully and actively B. Demonstrates Professional Growth 1. Exhibits enthusiasm about the profession 2. Self-regulates and modifies professional behavior based upon feedback 3. Is aware and involved with professional organizations, publications, and activities 4. Participates consistently and appropriately
2 C. Demonstrates Professional Relationships 1. Understands and respects diversity 2. Is respectful during interactions with school students, educational personnel, and families 3. Works collaboratively with other colleagues, university, and field supervisors 4. Completes high quality products in a timely manner D. Exhibits Attributes Suitable to the Profession 1. Adapts and is flexible to change 2. Displays excellent interpersonal skills 3. Maintains professional appearance 4. Displays initiative and reflective judgment 5. Provides leadership and problem solving E. Displays Responsible and Ethical Behavior 1. Adheres Professional Codes of Ethics of MU, NASP, and APA 2. Presents data honestly 3. Follows organizational protocol II. School Psychology A. Objectives, Domains, and Student Competencies (1) Enhance the development of wellness, resiliency, social skills, and life competencies. - Domain 2.4: Socialization and Development of Life Skills - Domain 2.7: Prevention, Crisis Intervention, and Mental Health 1. Help design and implement prevention and intervention programs to promote wellness and resiliency. 2. Work with school personnel, students, parents and the general community in the prevention of crises. 3. Help schools in developing achievable behavioral, affective, and adaptive goals for all students. 4. Be knowledgeable about development in social, affective, and adaptive domains and to apply sound principles of behavior change within these domains. 5. Provide leadership in creating instructional environments that promote student welfare and treats members of the school community with respect and dignity.
3 (Objectives, Domains, and Student Competencies Continued) (2) Enhance the development of cognitive and academic skills. - Domain 2.3: Effective Instruction and Development of Cognitive and Academic Skills 6. Recognize and apply empirically supported components of effective instruction and alternative instructional methodologies with integrity. 7. Assist teachers and others to improve instruction and enhance achievement. 8. Assist teachers and others in translating emerging critical research to instructional practice. (3) Provide leadership in promoting effective and caring systems that support learning. - Domain 2.6: School and Systems Organization, Policy, Development, and Climate 9. Understand how the systems work in which students live and learn. 10. Use their knowledge of systems to help organize schools and classrooms in ways that promote learning and prevent problems and a sense of community. 11. Understand public policy initiatives. (4) Make informed decisions based on data. - Domain 2.1: Data-Based Decision Making and Accountability - Domain 2.9: Research and Program Evaluation 12. Be good problem-solvers who collect information that is relevant for understanding problems in order to make decisions about appropriate interventions, assess educational outcomes, and help others assess accountability for the decisions they make. 13. Gather and integrate data about school systems, programs, and classroom environments through the use of: observations, interviews, standardized norm-referenced tests, functional behavioral assessment, curriculum-based assessment, ecological/environmental assessment, technology-enhanced assessment, and progress monitoring. (5) Practice in ways that meet all appropriate ethical, professional, and legal standards and with mindfulness of their social responsibility in serving others. - Domain 2.10: School Psychology Practice and Development 14. Practice in ways that meet all the appropriate ethical, professional and legal standards in order to enhance the quality of services and protect the rights of all parties. 15. Develop a continuing education plan for professional development beyond the training program. (6) Apply technology to improve outcomes and support their efforts in serving others. - Domain 2.11: Information Technology 16. Use technology to gather, evaluate, and enhance communication of information. 17. Know where and how to access technology, and how to evaluate its safety and value, and how to use it to enhance classroom learning.
4 (Objectives, Domains, and Student Competencies Continued) (7) Be aware of issues of diversity and provide sensitive quality service to diverse populations. - Domain 2.5: Student Diversity in Development and Learning 18. Recognize the impact of diversity on school settings and on student learning outcomes. 19. Assist schools to embrace and respect diversity. 20. Modify or adapt in response to diverse populations. (8) Assist with and monitor the development of those interpersonal and collaborative skills that will enable candidates to work effectively and cooperatively with others. - Domain 2.2 Consultation and Collaboration - Domain 2.8 Home/School/Community Collaboration 21. Understand the importance of collaboration and be able to facilitate it effectively in multiple contexts. 22. Listen to, and communicate effectively with, diverse audiences in both oral and written forms. III. School Psychology Practice and Development A. Basic Work Requirements 1. Arrives on time consistently 2. Uses time efficiently 3. Informs supervisor and makes arrangements for absences 4. Completes requested or assigned tasks reliably and on time 5. Completes required total number of hours or days on site 6. Is responsive to norms about clothing, language, etc. on site B. Response to Supervision 1. Actively seeks supervision when necessary 2. Is receptive to feedback and suggestions from supervisor 3. Understands information communicated in supervision 4. Successfully implements suggestions from supervision 5. Is aware of ideas that need improvement 6. Is willing to explore personal strengths and weaknesses
5 Evaluation Questions: What would you identify as areas in which this intern should improve? Would you recommend this student for doctoral studies? Signature of Field Supervisor/Date Signature of Intern/Date Thank you for your time in supervising this intern and for completing this evaluation.