Job Placement Evaluation

Student Job Placement Evaluation Form
Your Name:
Date:
Position Title:
Agency Name:
Address:
Phone:
Start Date:
Projected End Date:
Position Type
Average hours per week:
Salary:
Fringe benefits (e.g. vacation, insurance, tuition waiver, etc):
Primary Supervisor:
Secondary Supervisor:


Please describe the typical duties of your positon
Clinical Assessment (e.g., tests administered, interpretations, write-ups, case presentation):
Psychotherapy (e.g., number and type o clients, amount and type of client contact, group vs. individual):
Case Conference/Staff Meetings (e.g., format, frequency):
Research (e.g., scale administration/data collection, data reduction/scoring, data analysis, research meetings, involvement in formulation of design, write-up of results, involvement in presentation/publication of results, grant-writing experience):
Teaching (e.g., lecturing, grading exams, frequency, target group, training in methods):
Please list any other available training activities (e.g., Seminars, conferences, workshops, etc.):


Please describe extent and nature of supervision provided by each supervisor, indicating average time per week of supervision, percentage of supervision that is individual or group (i.e. sum should equal 100%), and number of supervisee in group supervision.
Primary Supervisor:
Secondary Supervisor:
Please list additional comments or information about the position, including your overall evaluation of the experience; any suggestions for improvement or concerns for future students; special strengths or advantages of the position.


Please indicate the average percentage of your time that is allotted to each activity listed below. This should add up to approximately 100%.
Teaching:
Instruction in teaching:
Grading Exams:
Formulation of research plan:
Research meetings:
Data Entry:
Data Collection/Analysis:
Project write up/presentation of results:
Interviewing:
Administration of test instruments:
Scoring Psychometric tests:
Test interpretation:
Report writing:
Case conference/team meetings:
Individuals therapy:
Group therapy:
Supervision:
Other (specify below):

Please select the number that corresponds to your evaluation of your job
How much did you enjoy your job?
Do you feel your job contributed to your training?

hidden