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Institution!/!Organiza tion!N am e
Clinic!Name!(Dept/Service/Unit)
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Below!
Average
Average
Very!
Good
Excellent
Exceptional
Cannot!
Judge
15%!
30%!
30%!
15%!
5%!
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1)!Test!Administration
2)!Interviewing
3)!Test!Interpretation
4)!Report!Writing
5)!Individual!Psychodynamic!
Therapy
6)!Individual!CBT!Therapy
7)!Other!Individual!Therapy!
8)!Group!Therapy!
9)!Family!or!Couple!Therapy!
10)!Communicating!Findings!to!
other!Professionals!
11)!Supervision!
12)!Research!
13)!Sensitivity!/!Skill!with!
Diversity!
14)!Involvement!in!Supervision!of!
Junior!Stude n t!Tr ain e es !
15)!Overall!Amount!Learned!from!
Participating!in!this!Training!Site!
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Explain!
Ratings
(Additional!information!and!explanation!of!ratings.)
Strengths!
(Strengths!of!the!training!site.)
Weaknesses!!
&!Potential!
Growth!Areas!
(Constructive!feedback!abo ut!po tential!gro w th!areas !to!imp rove!train ing!ex perien ce.)
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Inadequate
Below!Average
Average
Very!Good
Excellent
Exceptional
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APC 2011-2012
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