Name
Agency Assigned
Time Period for the Practicum:
Please complete the following form. It will be used in making
an assessment for agency selection in the future.
Agency
1. Were service/learning experiences provided that allowed you
to work with members of various ethnic groups?
Yes No Uncertain
2. Were appropriate supervision and instructional personnel
provided to ensure quality service/learning experiences?.
Yes No Uncertain
3. Were service/learning experiences provided that ensured
direct involvement with clientele in a manner consistent
with professional social work development?
Yes No Uncertain
4. Were there adequate space and supplies?
Yes No Uncertain
5. Were opportunities provided to utilize new approaches of
social work interventions?
Yes No Uncertain
6. Did the agency provide travel reimbursement for expenses
incurred while performing agency business?
Yes No Uncertain
7. Did the agency provide written copies of its rules and
regulations?
Yes No Uncertain
8. Did the agency provide easy access to records for learning
experiences?
Yes No Uncertain
9. Did the staff reflect the local diversity?
Yes No Uncertain
10. Was the agency and other staff members prepared for the
arrival of students?
Yes No Uncertain
11. Were opportunities available for exposure to the total
operation and activities of the agency?
Yes No Uncertain
Supervision
12. Were there appropriate service/learning experiences?
Yes No Uncertain
13. Were weekly instructional conferences held?
Yes No Uncertain
14. Did you have access to instructional personnel when
needed?
Yes No Uncertain
15. Was adequate time allotted for consulting with
instructional personnel?
Yes No Uncertain
Learning Activities
16. Were there opportunities to function within the structure of
organizations and service delivery systems and seek necessary
organizational change?
Yes No Uncertain
17. Were there opportunities to use theoretical frameworks supported
by empirical evidence to understand individual development and
behavior across the life span and the interactions among
individuals and between individuals and families, groups,
organizations, and communities?
Yes No Uncertain
18. Were there opportunities to apply the knowledge (from textbooks)
and skills of generalist social work practice with systems of all
sizes?
Yes No Uncertain
19. Were there opportunities to apply the value base of the
profession and its ethical standards and principles
(SW Code of Ethics), and practice accordingly?
Yes No Uncertain
20. Were there opportunities to evaluate research studies, apply
research findings to practice, and evaluate your own practice
interventions (applying knowledge from research classes)?
Yes No Uncertain
21. Were there opportunities to describe the forms and mechanisms of
oppression and discrimination and apply strategies of advocacy
and social change that advance social and economic justice?
Yes No Uncertain
22. Were there opportunities to use supervision and consultation
appropriate to social work practice?
Yes No Uncertain
23. Were there opportunities to learn to write clearly, concisely,
and with good grammar, punctuation, and spelling?
Yes No Uncertain
24. Were there opportunities to learn to speak clearly, concisely,
and with conviction?
Yes No Uncertain
25. Were there opportunities to use communication skills
differentially across client populations, colleagues, and
communities?
Yes No Uncertain
26. Were there opportunities to apply critical thinking skills within
the context of professional social work practice?
Yes No Uncertain
Impressions
27. How did you perceive yourself at the agency?
Student Visitor Staff Other Uncertain
28. How did the agency perceive you?
Student Visitor Staff Other Uncertain
29. Were the supervisory sessions beneficial?
Yes No Uncertain
(PLEASE START THE NEXT SECTION ON A SEPARATE PAGE)
Agency Name Academic Year Please TYPE responses for #30-33. Submit TWO COPIES of this page since one copy of it will be forwarded to the agency. Only one copy should be submitted of the preceding four pages.
30. What would you list as the positive features of the field
placement?
31. What would you list as the negative features of the field
placement?
32. Would you recommend this agency as a site for future
student placements? Why?
33. What recommendations would you make regarding this
placement site?
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