Self-Assessment Form

Student Self-Assessment of Competency

Key for Rating Scales
Rating your exposure:

Using the following scale, indicate for each item listed below whether you have been exposed to the item during the classroom, lab, or clinical situations. Add a (+) or a (-) to indicate a lot or a little exposure.

4 = Clinical, classroom, and lab; 3 = Clinical only; 2 = Classroom and lab; 1 = Classroom only; 0 = No exposure

Rating your competency:

Competency means to consistently perform the activity accurately, skillfully, and in the appropriate time and place. Under the competency column indicate how competent you feel in each using the following scale (comment to clarify as needed):

4 = Competent requiring only confirmation from CI; 3 = Competent with guidance from CI; 2 = Competent with supervisor physically present; 1 = Requires assistance to complete skill completely

Evaluation Procedures
Training Procedures
Affective Skills
Treatment Procedures
Types of Diagnosis