Students' Self-Evaluation Form

Name _________________________________ 

Academic Year  _____________________                                                    

Date Form was completed __________________  

Date Benchmark Database was completed __________________
 
1.   Please check off the doctoral program courses you have
      completed, including equivalent course credits.
 
___      EDPS 50000 - Group Counseling Theories and Techniques
___      EDPS 50500 - Career Theory and Information
___      EDPS 50700 - Counseling Multicultural and Diverse Populations
___      EDPS 53300 - Introduction to Edu Research I: Methodology
___      EDPS 60000 - Counseling Theories and Techniques
___      EDPS 60100 - Counseling Theories and Techniques Laboratory
___      EDPS 60400 - Advanced Counseling Theories and Interventions
___      EDPS 61400 - Advanced Counseling Practicum
___      EDPS 61400 - Adv Offsite Counseling Practicum
___      EDPS 61700 - Prof Issues, Ethics, & History of Counseling Psy
___      EDPS 61900 - Counseling Psychology Research Practicum
___      EDPS 62000 - Counseling Seminar
___      EDPS 62100 - Adv Multicultural Counseling Theory & Practice
___      EDPS 62200 - Systems Concepts in Counseling and Dev
___      EDPS 62300 - Personality Assessment
___      EDPS 63000 - Research Procedures in Education
___      EDPS 69600 - Internship in Counseling Psychology
___      EDPS 69900 - Research Ph.D. Thesis
___                          - Advanced Methods/STAT
___      PSY 54000 - History of Psychology
___      PSY 60000/STAT 50100 - Statistical Inference
___      PSY 60100/STAT 50200 - Statistics II-Correlation & Exp Design
___      PSY 67300 - Psychology of Behavior Disorders
___      PSY Biological Core (615)
___      PSY Social Core (640)
___      PSY Cognitive Core
___      PSY Development (502 or 656)

Elective Courses:

EDPS 60200-Adv Group Counseling Theories and Techniques
EDPS 60500-Adv Career Development Theory and Research
 
Please go back and circle those classes COMPLETED this academic year.
 
_______  2.   Date and University of your Master's degree
_______  3.   Date plan of study was (or will be) filed (month/yr)
_______  4.   What is your current cumulative GPA? 
_______  5.   Date 200 research hours completed or planned
_______  6.   Date conference presentation/publication completed 
                    or planned
_______  7.   Date Work Sample completed
_______  8.   Date research project/paper requirement completed 
                    or planned
_______  9.   Date Written Prelims completed or planned
_______  10. Date of Oral Prelim
_______  11. Off-Site Practica completed or planned
           
Dates            Location                Client Population               #Clients seen
            _________________________________________________________________
            _________________________________________________________________

_______  12. Date Dissertation Proposal accepted (or plan to propose)
_______  13. Date Dissertation defended (or plan to defend)
_______  14. Date applied or plan to apply for internship
_______  15. Date internship completed or plan to complete 
            
Location:  _________________________    APA Accredited? _____________

_______  16. List professional organization memberships: 
_______  17. List conferences/workshops/seminars attended this
                     semester:             
_______  18. Give the reference for any publications or presentations
                    form this year 
 
Use this scale to rate your development on program objectives.   Remember, year in the program will influence acquisition of skills and knowledge (see Counseling Psychology Home Page).

1 - Very Minimal
2 - Developing as Expected
3 - Entry Level
4 - Expected
5 - Competence                  

Goal 1: Inquiry skills for advancing psychological knowledge and
           diagnosis and intervention.
 
___  1.  Knowledge of research designs and quantitative and qualitative
             inquiry.
___  2.  Ability to think critically about theories, research findings, and
            counseling practice, including analysis, evaluation, synthesis,
            integration, and application.
___  3.  Can formulate hypotheses and conduct original scientific 
            inquiry. 
 
Goal 2: Provide counseling, consultation, and psychoeducational
            services to clients and consumers from a sound theoretical
            and research base.
 
___  4.  Have foundational knowledge of psychological theories of
            counseling practice.
___  5.  Have established a coherent theoretical orientation to
            counseling psychology practice based on an integration
            of theory and contemporary research.
___  6.  Demonstrate proficiency in service delivery including individual
            and group counseling, consultation, psychological
            assessment, and programmatic interventions.
 
Goal 3: Demonstrate ethical and professional behavior consistent with
           the profession. 
 
___ 7.  Am knowledgeable about and understand ethical, legal, and
           professional standards and ethical decision-making models
           in counseling psychology.
___ 8.  Identify and think critically about ethical and professional
           dilemmas.
___ 9.  Demonstrate ethical and professional behavior across all
           professional settings.
 
Goal 4: Provide competent services that are responsive to individual
           and cultural differences in a multicultural environment.
           ["Cultural and individual diversity' refers to diversity with
           regard to personal and demographic characteristics. These
           include, but are not limited to, age, color, disabilities, ethnicity,
           gender, language, national origin, race, religion, sexual
           orientation, and social economic status" (APA G&P, p. 5).] 
 
___10.   Have attained foundational knowledge of multicultural theories
              and the sychosocial characteristics of various multicultural
              populations.
___11.   Have developed the ability to evaluate prevailing psychological
              theory and practice from a multicultural perspective.  This
              ability includes personal awareness of the impact of cultural
              and dimensions, on the development, validation, and
              application of counseling psychology theory,
              technique, and assessment.
___12.   Demonstrate competence in general and specific skills that
              facilitates cross-cultural relations in both counseling and
              professional settings.
 
General Goals:
 
___13.   Being collegial and contributing to the energetic, respectful,
             and collaborative student-faculty atmosphere.
___14.   Understand and implement the scientist-practitioner training
             model.
___15.   Knowledge of counseling psychology & identification as a
             counseling psychologist.
___16.   Openness to learning and supervision.
___17.   Self-awareness, self-reflection, and self-evaluation.
___18.   Self-directed on going learning and development (e.g.,
             reading beyond class assignments)
___19.   Resolution of issues or problems that interfere with
             professional development or functioning in a satisfactory
             manner (e.g., seeking personal therapy when appropriate).
___20.   Writing, including APA style, including grammar, sentence
             construction (e.g., varied sentence construction), punctuation,
             et cetera.
___21.   Timely completion of the program.

 
Questions/Comments for the Core Counseling Psychology Faculty (Use as much space as needed).