Supervisor Evaluation Form Directions: Please rate yourself as you imagine your supervisee would rate you.

Provide an explanation for why you chose each rating and what, if anything, you could do to improve in each area. 1. Availability of supervisor; Provides 2-hours individual supervision weekly & informal supervision as needed. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

2.

Committed to intern's growth and development; Priorities the intern's training over service delivery demands.

___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent

What have you done to demonstrate this rating:

How could you improve in this area:

3. Demonstrates responsibility for cases by signing notes/reports; Is aware of and involved in all aspects of the intern's service delivery. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

4. Effective use of time in supervision; Engages intern in case conceptualization & professional development. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

5. Provides close mentoring/support when needed. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

6. Allows autonomy as intern's competence increases. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

7. Demonstrates knowledge of the literature; Suggests empirically- supported practices. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

8. Effectively resolves conflict within the supervisory relationship; Builds trust. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

9. Provides specific, timely and constructive comments on the intern's competence and limitations. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

10. Elicits and is responsive to intern feedback on the supervisory relationship and internship experience. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

11. Encourages intern's self-awareness and reflection. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

12. Models a commitment to cultural competence. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

13. Engages in professional development; Keeps abreast of developments in the field. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

14. Establishes achievable goals; In addition to addressing the indicators listed on the internship plan, the supervisor is sensitive to the unique training needs of the intern. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

15. Establishes clear and realistic expectations for supervision; Clarifies the role of the various supervisors and supervisees. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

16. Helps in selecting appropriate professional experiences; Arranges opportunities with a broad range of services and individual differences. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

17. Is helpful with support/information about maintaining relationships with co-workers. ___ Poor/marginal ____Adequate ____Good ____Very good ____Excellent What have you done to demonstrate this rating: How could you improve in this area:

18. Identify 2-3 areas that you will focus on for improvement this year.