Counselor Evaluation Rubric Form
Please complete this structured rubric to assess the counselor’s performance. Your feedback is valuable and will remain confidential.
Counselor’s Name
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Communication Skills (Clarity, Listening, Responsiveness)
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Professionalism (Reliability, Ethics, Boundaries)
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Empathy and Supportiveness
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Effectiveness in Addressing Concerns
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Respect for Diversity and Inclusion
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Overall Performance
*
1
2
3
4
5
Strengths Observed
Areas for Improvement or Additional Comments
Submit Evaluation
Should be Empty: