Student Feedback Form - DOC by fDQ7Zq


									                                   Student Feedback Form
                                Counseling Psychology Program
                                     Auburn University
                                    Form Revised 04/04/07

In order that faculty may have complete and up-to-date information about your accomplishments
and activities in the Counseling Psychology Program prior to annual evaluations, please
complete the following and return to your advisor not later than April 11, 2007. Please type in
your answers to the questions below

It is not expected that you will have activities/accomplishments in each of the areas.

Unless otherwise noted, all questions refer to the inclusive period April 11, 2006BApril 11,

Name: ________________________________________

Advisor: ______________________________________

Year you entered the program: _____________________

1A. Please list the courses you have completed during the last year, and the grades you earned
(start with Spring, 2006 and go through Fall, 2006, unless you entered in the Fall, in which case
you should list only your fall course grades). Also list the courses in which you are currently
enrolled. Please note any course in which you are currently enrolled for which your grade is
currently below a AB.@

1B. Have you filed a plan of study (if yes, when)
1C. Have you filed a residency form (if yes, when)
1D. Date you anticipate going on internship:
1E. Date you did or intend to propose:
2. Please list your assistantship and other program-related (but not practicum) paid positions with
dates since May 10, 2006. If your practicum was labeled an assistantship, do not list here, but
provide note in #3 below. Please provide a brief summary of what you did, how many hours
your worked per week, and who your supervisors were.

3. If you were in practicum, where was it (include rotations if appropriate) and who have been
your supervisors (on-site and university)?

4. If you took your written prelims this past year, please list your outcomes (all ratings) by
subject area.

5. Please list your program-related, non-practicum, non-GTA activities since May 10, 2006. An
outline is provided below:

a. Convention papers which were submitted, accepted, or presented (indicate which). List
authors and title of papers. Also include manuscripts submitted to, e.g., an APA Divisional
competition, the APA student ethics paper competition, etc.

b. Journal articles/chapters/books published, accepted, or submitted. Please use APA style. .

c. Conventions attended. Indicate if you were the presenting author on a paper.
d. Workshops or presentations given

e. Workshops or presentations attended (note if voluntary attendance)

f. Auburn University Graduate Student Research Forum presentation

g. Member of research team (topic and faculty leader of research team). If you were the author
or co-author of a grant application growing out of a research team, list here and whether funded
or not.

h. Other professional activities (e.g., serving as APAGS representative, working on a SAG
committee, doing volunteer work at a convention, etc. Include comments here that describe
activities (if not described above) documenting you competency and/or involvement in diversity
related activities)

i. Volunteer work not otherwise listed that is program-related (e.g., worked as telephone

j. Professional activity (if not described above) within the department (e.g., served on a
committee, assisted with departmental project, assisted with the admissions process (e.g., wrote
applicants, served as mentor/contact person, hosted party, let someone stay at your house,
attended and/or assisted with lunch or social etc.)

k. Student memberships/affiliations (e.g., APA, APS, SAS (Student affiliate of Div 17), etc)

l. Other activities not described above. Feel free to comment on informal ways in which you
believe you have contributed to your program or peers. Also comment on events which you feel
demonstrate your competency and/or professionalism.

6. Please list other honors, recognitions, accomplishments, awards, and grants. Include travel
awards from, e.g., APA, the College of Education, or the Graduate School.

7. If you applied for internship, please note outcome and, if you were placed, the ranking (in
priority) you gave the place where you are going.

8. Please make any additional comments you would like the counseling psychology faculty to
consider in your evaluation. We encourage self-evaluation.

Finally, please make any additional comments you would like the counseling psychology faculty
to consider in its discussion of the program in general. We solicit feedback about the program to
help us improve it. If there is feedback you would like the counseling psychology faculty to have
and you do not feel comfortable attaching your name, type those comments on a separate page,
seal in an envelope, address the envelope to Dr. Pipes and give to Ms. Nancy Evans. Ms. Evans
will place the envelope in Dr. Pipes=s box. If you prefer, you may give anonymous comments to
Stephanie Graham as student representative.


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