Addictions Treatment Practicum Assessment Form *Denotes Required Field * Title * Student's Name: * Ministry Location and Type: * Supervisor (your) Name: * Phone or email: Please help us evaluate this student's practicum experience. Your input is a valuable part of their training and growth. Please give comments where possible as these give a better overall picture. Also, whenever possible, we encourage you to review your evaluation in person with the student before submitting them to the school. Please reserve "5 (Outstanding)" only for those areas where the student has truly excelled. A student who serves well should score mostly 4's with perhaps some 5's and/or 3's. You may make additional comments in the spaces provided. * 1. The student conducted himself/herself in an exemplary manner. They exhibited honesty, integrity, politeness, discernment, appropriate professionalism, and overall character. They were teachable and open to feedback. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 2.The student demonstrated an openness to feedback and a willingness to improve their skills. They took advice to heart and took practical steps to improve. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 3. The student served proactively, often going above and beyond stated expectations. They were intentional about maximizing both their own service and the effectiveness of the team. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 4. The student communicated and worked well with the team. They demonstrated proper respect for the leadership and were friendly and cooperative towards the team. They handled team conflicts in a healthy manner. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments (you may also email comments privately to Brad Cowie (bcowie@prbi.edu) if you do not want them recorded here): 5. The student was reliable. They attended as required, with minimal or no absences. If necessary, they were proactive about finding a replacement and/or notifying the ministry as expected. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 6. The student demonstrated spiritual authenticity. They demonstrated that they take their faith seriously, and conducted themselves in a manner that is consistent with their stated beliefs and values. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 7. The student demonstrated a genuine love for others, especially those they served. They exhibited kindness, patience, and grace towards people. They handled interpersonal relationships and conflicts well. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 8. The student was organized and self-disciplined. They always came properly prepared for their tasks, and faithfully completed tasks assigned to them without needing excessive supervision. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 9. Given their natural personality (not everyone is an extrovert), the student seemed genuinely sincere and enthusiastic about their service. They were easy to work with and demonstrated a healthy attitude. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: 10. The student seemed suitably gifted for this type of service. They demonstrated appropriate skills, attitudes and intuitions. They were effective and/or showed significant potential in working with people with addictions. 5 Outstanding 4 Very Good 3 Acceptable 2 Needs to Improve 1 Unacceptable Additional Comments: * Which of the following statements best summarizes your overall assessment of this student? (50) Beyond expectations in multiple areas (45) High quality, consistent service and attitude (40) Faithful, willing, and reliable service and attitude (35) Good, but more duty than passion. Got the job done (30) Struggled to fulfill expectations. Inconsistent at times (25) Unreliable, only partially fulfilled responsibilities (20) Failed to fulfill responsibilities at an acceptable level * Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 * Did you have an opportunity to review this evaluation with the student? Yes No Additional Comments (you may also email comments privately to Kim Cairns (kcairns@prbi.edu) if you do not want them recorded here):
