STUDENT EVALUATION OF COOPERATING ADMINISTRATOR
The purposes of this form are: (1) to provide feedback for improving the practicum, and (2) to encourage communication between the cooperating administrator and the student. The student must complete the form at the end of the practicum experience and return it to the university professor by the last week of the semester.
Name of Cooperating Administrator: ____________________________________________________________
EDIL 610 Practicum Semester: ________________________________________________________________
Directions:
Circle the number that best represents how you felt about the mentoring received. Then return the form to the university professor at the due date.
Deficient Good Excellent
1. Gave time and energy in observing 1 2 3 4 5 6
and interacting with me.
2. Accepted and respected me as a person. 1 2 3 4 5 6
3. Recognized and encouraged further 1 2 3 4 5 6
development of my abilities.
4. Gave me useful feedback. 1 2 3 4 5 6
5. Helped me to define and achieve 1 2 3 4 5 6
concrete goals during the practicum.
6. Allowed me to discuss problems I 1 2 3 4 5 6
encountered in the practicum.
7. Helps me define and maintain ethical/ 1 2 3 4 5 6
professional behavior.
8. Maintained confidentiality in material 1 2 3 4 5 6
discussed in supervisory sessions.
9. Offered resource information when I 1 2 3 4 5 6
request of need it.
10. Allowed and encouraged me to evaluate 1 2 3 4 5 6
my performance.
11. Explained his/her criteria for evaluation 1 2 3 4 5 6
clearly.
12. Applies his/her criteria fairly in 1 2 3 4 5 6
evaluating my performance.
Additional Comments and/or Suggestions:______________________________________________________________________________________
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Name of Student: __________________________________________________________________________________________________________
_________________________________________________ ____________
Student Signature Date