Internship Manual - Wayne State College

FEEDBACK FORM FOR COUNSELORSWayne State College – Counselor Education1111 Main St., Wayne, NE 68787We want to be able to serve people participating in individual or group counseling and the education of counselors in thebest possible way. To do this, we need your help. Please complete the following evaluation form and return it to us at theaddress above. You do not need to identify yourself. The information you provide will be used in the education ofcounselors. Thank you!Name of Counselor ______________________________________________Your Age ___ Male or Female Date_________ Number of times you met with counselor: once(circle) 2-56 or more1. Did the counselor listen to you and understand what you were saying?Listened to everythingI said andunderstood me5 4Listened andunderstood me3 2Didn’t listen orunderstand me at all12. Did you think the counselor cared about you and your feelings?Extremely interestedin me5 4Interested in me3 2Not interested in me atall13. Did the counselor respect you and your thoughts and opinions?Always respectedme and my opinions5 4Respected meand myopinions3 2Did not respect me andmy opinions14. Did you feel you could talk openly about anything with the counselor?Felt I could talkopenly about anything5 4Felt I could talkopenly aboutsome things3 2Felt I could not talk aboutanything important to me15. Did you meet enough times to feel that counseling helped you?Yes5 4Somewhat3 2No16. Did counseling help you learn anything?Learned a great deal5 4Learned some3 2Learned nothing17. Did you change anything about yourself (your ideas, attitudes, or actions)?