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1. Date

 4/30/2012
 (25%) 
 
 5/2/2012
 (75%) 
 

Total: 8

2. Student’s Name

 Ashley Arenholz
 (13%) 
 
 Jennifer Berman
 (13%) 
 
 Emily Gnefkow
 (13%) 
 
 Benjamin Holloway
 (13%) 
 
 Marieka Jones
 (0%)  
 Brittany Johnson
 (13%) 
 
 Cara Smith
 (13%) 
 
 Erica Taylor
 (0%)  
 Ashley Vega
 (0%)  
 Cathleen Wilkinson
 (13%) 
 
 Shante' Williams
 (13%) 
 

Total: 8

3. Community Organization (practicum site)

 CHIP: Community Health Improvement Partnership
 (13%) 
 
 Lawrence Memorial Hospital
 (13%) 
 
 JDRF
 (0%)  
 Truman Medical Center
 (13%) 
 
 Douglas County Health Department
 (13%) 
 
 GaDuGi Center
 (13%) 
 
 Lawrence-Douglas County Housing Authority
 (13%) 
 
 Disability Rights Center
 (13%) 
 
 KUWG
 (13%) 
 

Total: 8

4. Student's commitment to the practicum experience:

 Consistently Committed (5 Points)
 (88%) 
 
 Almost Always Committed (4 Points)
 (13%) 
 
 Usually Committed (3 Points)
 (0%)  
 Disengaged (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 8

5. Student's work habits to date:

 Excellent (5 Points)
 (63%) 
 
 Very Good (4 Points)
 (38%) 
 
 Somewhat Inconsistent (3 Points)
 (0%)  
 Poor (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 8

6. 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: 8

7. The quality and timeliness of the final practicum product(s) submitted by the student:

 Very Satisfied (15 Points)
 (88%) 
 
 Satisfied (12 Points)
 (0%)  
 Somewhat Dissatisfied (9 Points)
 (13%) 
 
 Dissatisfied (6 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 8

8. 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: 8

9. Student's relationship with others in the organization: (e.g. The student established 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: 8

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

 Very Positive (5 Points)
 (88%) 
 
 Fairly Positive (4 Points)
 (13%) 
 
 Occasionally Negative (3 Points)
 (0%)  
 Too Often Negative (1 Point)
 (0%)  
 Unable to Evaluate (0 Points)
 (0%)  

Total: 8

11. 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: 8

12. Supervisor’s ability to provide direction and support to the student’s practicum objectives: (No points awarded)

 Very Good
 (75%) 
 
 Fairly Sufficient
 (25%) 
 
 Occasionally Insufficient
 (0%)  
 Often Insufficient
 (0%)  
 Unable to Evaluate
 (0%)  

Total: 8

13. Supervisor's level of dependability to date: (No points awarded)

 Consistently Dependable
 (100%)  
 Almost Always Dependable
 (0%)  
 Sometimes Undependable
 (0%)  
 Often Undependable
 (0%)  
 Unable to Evaluate
 (0%)  

Total: 8

14. Would you recommend this site for future practicum  students?

 Yes
 (100%)  
 No
 (0%)  

Total: 8

15. If you are required to complete an additional semester of practicum, are you interested in being placed at this site again in the future?

 Yes
 (88%) 
 
 No
 (13%) 
 

Total: 8

16. Please enter any additional feedback regarding the practicum organization.  (This information will not be shared with the practicum site.)

 My site supervisor was very positive and helped me establish great networking skills. Everyday she gave me a great tip for workplace etiquette.
 (14%) 
 
 
Excellent opportunity to be a part of the community and to assist those that need extra help. Terrific staff, great hours, and amazing clients. I thoroughly enjoyed working here for nearly a year! Thank you for giving me the opportunity!
 (14%) 
 
 
Janelle is great. She is always willing to work with me and help me out on projects. It was the best internship I have ever done, and I would recommend other students to work with CHIP and Janelle.
 (14%) 
 
 Christina was a great supervisor to work with!
 (14%) 
 
 
I loved GaDuGi! It was the best placement for me! I'm sad my practicum is over!
 (14%) 
 
 For someone who is interested in developmental disability issues, this is a great practicum placement. I was able to work behind the scenes to bring real change to an issue that effects nearly 5,000 people in Kansas. I was also able to participate in exciting events (Lawrence Resource Expo & Push Day) and talk with people about the End The Wait Campaign & increase awareness & involvement.
 (14%) 
 
 Great year, thanks so much! Rock chalk!
 (14%) 
 

Total: 7