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1. Date

 4/30/2012
 (100%)  

Total: 1

2. Supervisor's Name

 Cathy Brashler
 (0%)  
 Becki Carl-Stutz
 (100%)  
 Rick Cagan
 (0%)  
 Mike Caron
 (0%)  
 John Drees
 (0%)  
 Erika Dvorske
 (0%)  
 Chiaki Gonda
 (0%)  
 Matt Fletcher
 (0%)  
 Joshua Hoffman
 (0%)  
 Kenton Holder
 (0%)  
 Anna Lambertson
 (0%)  
 Janelle Martin
 (0%)  
 Amy Pinger
 (0%)  
 Adrion Roberson
 (0%)  
 Jomella Watson-Thompson
 (0%)  
 Dola Williams
 (0%)  
 Paul Youk
 (0%)  

Total: 1

3. Community Organization (practicum site)

 Ballard Center
 (0%)  
 Big Brothers/Big Sisters
 (0%)  
 Boys & Girls Club
 (0%)  
 CHIP: Community Health Improvement Partnership
 (0%)  
 Communities In Schools
 (0%)  
 Douglas County Jail
 (0%)  
 Interhab
 (0%)  
 Kansas Consumer Health Coalition
 (0%)  
 Lawrence Memorial Hospital
 (100%)  
 National Alliance on Mental Illness
 (0%)  
 Neighborhood Association
 (0%)  
 Research Training Center
 (0%)  
 Healthy Kids Club-Rosedale
 (0%)  
 Safe Kids of Douglas County
 (0%)  
 United Way of Douglas County
 (0%)  
 Unity in the Community
 (0%)  
 Wyandotte County Youth Football and Cheerleading Association
 (0%)  
 YWCA-Topeka
 (0%)  

Total: 1

4. We appreciate your frank and honest responses to the following student evaluation.  Your feedback assists the course instructors with the education and future placement of practicum students.  This information is also useful for the professional development of the students.

Please indicate whether you consent to our sharing of your evaluation responses with the practicum student whom you supervise.

 Yes, I consent to the sharing of my responses with the student
 (100%)  
 No, I do not consent to the sharing of my responses with the student
 (0%)  

Total: 1

5. Student's commitment to the practicum experience:

 Consistently Committed (5 Points)
 (100%)  
 Almost Always Committed (4 Points)
 (0%)  
 Usually Committed (3 Points)
 (0%)  
 Disengaged (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

6. (1) Comments:


Total: 0

7. Student's work habits to date:

 Excellent (5 Points)
 (100%)  
 Very Good (4 Points)
 (0%)  
 Somewhat Inconsistent (3 Points)
 (0%)  
 Poor (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

8. (2) Comments:


Total: 0

9. Overall quality of student's effort (e.g., amount learned, skills learned, etc.):

 Very Satisfied (5 Points)
 (100%)  
 Satisfied (4 Points)
 (0%)  
 Somewhat Dissatisfied (3 Points)
 (0%)  
 Dissatisfied (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

10. (3) Comments:


Total: 0

11. The overall quality of the practicum product(s)/project that was received from the student:

 Very Satisfied (15 Points)
 (100%)  
 Satisfied (12 Points)
 (0%)  
 Somewhat Dissatisfied (9 Points)
 (0%)  
 Dissatisfied (6 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

12. (4) Comments:


Total: 0

13. Student's interaction with others at the site (e.g. staff, clients):

 Consistently Positive (5 Points)
 (100%)  
 Almost Always (4 Points)
 (0%)  
 Occasionally Negative (3 Points)
 (0%)  
 Frequently Negative (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

14. (5) Comments:


Total: 0

15. Student's relationship with others in the organization: (e.g.  effective working relationships within the organization and the community.)

 Very Satisfied (5 Points)
 (100%)  
 Satisfied (4 Points)
 (0%)  
 Somewhat Dissatisfied (3 Points)
 (0%)  
 Dissatisfied (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

16. (6) Comments:


Total: 0

17. Student's overall attitude toward the activities and personnel associated with the practicum:

 Very Positive (5 Points)
 (100%)  
 Fairly Positive (4 Points)
 (0%)  
 Occasionally Negative (3 Points)
 (0%)  
 Too Often Negative (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

18. (7) Comments:


Total: 0

19. Student's understanding of practicum objectives:

 Very Good (5 Points)
 (100%)  
 Fairly Sufficient (4 Points)
 (0%)  
 Occasionally Insufficient (3 Points)
 (0%)  
 Often Insufficient (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 1

20. (8) Comments:


Total: 0

21. Student's level of dependability to date:

 Consistently Dependable (4 points)
 (100%)  
 Almost Always Dependable (3 points)
 (0%)  
 Sometimes Undependable (2 points)
 (0%)  
 Often Undependable (1 point)
 (0%)  
 Unable to Evaluate (0 points)
 (0%)  

Total: 1

22. (9) Comments:


Total: 0

23. Would you be willing to host this practicum student for an additional semester? Note: This information will not be shared with the student.

 Yes
 (100%)  
 No
 (0%)  

Total: 1

24. (10) Comments:


Total: 0

25. As compared to other interns and practicum students that you have hosted in the past (from any institution), how would you rate the professional performance of your current practicum student?

 1. Among the best
 (100%)  
 2. Above average
 (0%)  
 3. Average
 (0%)  
 4. Below average
 (0%)  
 5. Among the worst
 (0%)  

Total: 1

26. (11) Comments:


Total: 0

27. Please enter any additional feedback regarding your final assessment of the practicum student's performance.

 
 (100%)  

Total: 1