Brian Sieminski completed a field placement evaluation at Northland Behavioral Health & Wellness. He was rated as excellent in all evaluation criteria by his supervisor, Amy Shoffner. Specifically, he demonstrated excellent communication skills, professionalism, listening skills, and ability to complete all tasks in a timely manner even with little direction. His only area for improvement was to be more confident in his work. Overall, he related well with all staff and clients, took initiative, and made a significant positive impact at the organization during his placement.

1. PS407 Park University Field Placement Evaluation Form Page 1 of 3 Last updated 4/21/2015
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This content cannot be reproduced without permission.
Park University Field Placement Evaluation Form
Student: Brian Sieminski
Rater/ Title/ Organization: Amy M. Shoffner, Psy.D. / Northland Behavioral Health &
Wellness
Evaluation Criteria: please rate the student on the following scale:
Excellent Above
Average
Average Below
Average
Not
Acceptable
Not
Applicable
1 Observance of
work hours
X
2 Ability to
follow
directions/
procedures
X
3 Completion of
assigned tasks
and duties at
field placement
X
4 Timeliness:
appointments
& deadlines;
scheduling
adjustments
X
5 Initiative/
Creativity in
carrying out
tasks
X
6 Ability to
maintain
effective
working
relationships
with
organization
staff
X
7 Ability to relate
effectively with
clients
X
8 Judgment/
discretion in
X

2. PS407 Park University Field Placement Evaluation Form Page 2 of 3 Last updated 4/21/2015
© Copyright Park University, 2009. All rights reserved.
This content cannot be reproduced without permission.
dealing with
clients and/ or
other agency
matter
9 Interviewing/
listening skills
X
10 Referral/
utilization of
other agencies
n/a
11 Dealing
effectively with
representatives
of other
agencies
X
12 Sensitivity to
work with
diverse clients
and staff
X
13 Overall helping
skills and
behaviors
X
14 Student’s
congruence to
working in the
field placement
X
15 Overall
evaluation
X
Please fill out the open ended questions on the next page

3. PS407 Park University Field Placement Evaluation Form Page 3 of 3 Last updated 4/21/2015
© Copyright Park University, 2009. All rights reserved.
This content cannot be reproduced without permission.
Evaluator: Amy M. Shoffner, Psy.D. / Northland Behavioral Health & Wellness
Student: Brian Sieminski
Location: Northland Behavioral Health & Wellness
COMMENTS
Special Strengths/ Abilities: Brian has excellent communication skills. He asserts
himself clearly and is an active listener in all communication interactions. He is able to balance
professionalism with an easy manner which is a critical skill in mental health. He responds to all
staff and clients with a polite and nonjudgmental manner.
Areas for Improvement: Brian is excellent at accomplishing tasks of high quality even
when given very little direction. I would like to see him more confident about his completed
work.
SUMMARY OBSERVATIONS:
Brian is a bright and competent student and professional. He possesses strong skills in the areas of
communication, professionalism, listening, and technology. He was able to complete all tasks in a
timely manner even when given very little direction. He took initiative when seeing ways he could be
helpful. He related with all staff and clients in a courteous, professional, and nonjudgmental manner.
He would willingly participate in role-plays when teaching clients assertiveness. He made a significant
impact in our mental health practice and will be missed.