Thank you for completing this evaluation. It is important to us that you have a helpful practicum/internship experience. This feedback will be used by our Board of Directors to evaluate our internship site and address any deficiencies. It may also be used to provide statistics to potential donors, grant funders, etc.

Name *

First Name

Last Name

Email *

I agree to CCS using using feedback from this form (specifically comments) for purposes including, but limited to, advertising for the program, recruiting board members, and seeking funding. Student names will not be shared. *

Yes

I was provided with a clear overview of objectives/activities/expectations of internship. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

My practicum/internship experience enhanced my understanding of concepts in my counseling practice. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I was provided with levels of responsibility consistent with my ability and growth. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I received adequate guidance and constructive feedback. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I received adequate guidance and constructive feedback. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

My supervisor was available as needed for consultation, crisis, etc. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

My supervisor provided regular supervision. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I was assigned an appropriate caseload for my ability, comfort level, etc. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

My ideas, viewpoints, suggestions, etc. were considered. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I learned other skills in my practicum/internship such as insurance, billing, providing referrals, cultivating referral sources, etc. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I feel confident moving into my next career step (ie: t-LMHC) after this practicum/internship experience. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I felt positive about providing these services at zero cost to the clients. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

The environment was appropriate. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

I was encouraged to grow personally and/or professionally. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

Work/Life balance was respected and encouraged. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

My supervisor complied with the requirements of my school in regards to my practicum/internship (ie: having a licensed clinician onsite while seeing clients). *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

My supervisor modeled ethical decision making. *

Completely Disagree

Disagree

Neutral or N/A

Agree

Completely Agree

What was the MOST valuable component of your practicum/internship experience? *

What was the LEAST valuable component of your practicum/internship experience? *

Would you work for this organization again? *

Why or Why not (regarding working here) *

Would you recommend this organization to other students? *

Why or Why not (regarding recommending this organization) *

Any other feedback? *

Thank you for your time in completing this evaluation. Your work an dedication to the counseling field is appreciated!

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