Name of Student:
Name of Supervisor:
Agency:
Address:
Phone: Hours Completed: Date:
Directions:
A meaningful performance evaluation must give an accurate
description of the student's performance in carrying out
assignments. Nine field outcomes guide the expected
learning experiences. Please rate the student on the nine outcomes
based on the activities and performance criteria outlined in the
Student Field Practicum Contract.
Please utilize the following scale to indicate your estimation of
the student's level of current functioning. You may include
fractions (e.g., 3.5) if they provide a more precise
indication of the student's performance. This evaluation
accounts for 35% of the student's overall grade in the course.
4 = Excellent Performance is consistently above what is
expected
3 = Above Performance is above what is generally expected.
Average
2 = Average Performance is at the expected level.
1 = Below Ave. Performance is frequently below expected level.
0 = Poor Unable to perform
NA = Not No opportunity to perform this in practicum.
Applicable
Conclude with a statement summarizing strengths and areas for
attention or further development.
Outcome #1
To understand the organizational purpose, mission, goals, and
structure of an agency.
STUDENT ACTIVITIES/TASKS
- Read agency manuals, reports, etc.
- Interview Executive Director and/or Administrator of
Community Services.
OUTCOME MEASURES: Student will be able:
RATING
To share accurate information about the agency's goals,
mission, purpose and structure with clients and other
persons via telephone conversations, in-person-contacts,
etc.
To act and perform tasks in a way that is not in conflict
with the agency's purpose, mission or goals.
COMMENTS:
Outcome #2
To use theoretical frameworks supported by empirical evidence to
explain individual development and behavior across the lifespan.
STUDENT ACTIVITIES/TASKS
- Select at least one theoretical framework (from classes/readings)
and discuss with supervisor how it may explain the development and
behavior of individual clients at different locations along the
lifespan.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate an understanding of how theories may help to
explain human development and behavior along the lifespan.
COMMENTS:
Outcome #3
To identify and assess situations with individuals using generalist
practice knowledge.
STUDENT ACTIVITIES/TASKS
- Review case records.
- Interview clients.
- Discuss situations with supervisor and other agency staff.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate skills in assessing the person -
situation - environment using generalist practice knowledge.
COMMENTS:
Outcome #4
To develop intervention plans that meet clients' needs (individuals)
while maintaining the Code of Ethics for social work practice.
STUDENTS ACTIVITIES/TASKS - Observe and discuss services being provided to clients. - Interview clients (individuals). - Develop treatment or intervention plans for (___ number of clients)
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate interviewing skills with individuals.
To demonstrate skills in planning appropriate
services/activity in assigned cases.
COMMENTS:
Outcome #5
To understand published research and its applicability to the practicum agency and its service delivery system.
STUDENTS ACTIVITIES/TASKS
- Read at least one article of relevant published research and
discuss with the supervisor its applicability to the
practicum agency.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate an understanding of the applicability of
this particular published research to client population
served by the agency.
COMMENTS:
Outcome #6
To develop an understanding of and sensitivity to, culturally
diverse groups (relating to staff and individual clients).
STUDENTS ACTIVITIES/TASKS
- Read books and other materials dealing with this issue.
- Talk to staff about their experience and understanding in
this area.
- Observe and participate in sessions with diverse clients.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate an understanding of human behavior
as it is affected by age, class, race, ethnicity,
gender and sexual orientation.
To demonstrate an ability to accept and relate
effectively with staff and clients of diverse backgrounds.
COMMENTS:
Outcome #7
To use supervision to enhance learning. STUDENTS ACTIVITIES/TASKS - Schedule and participate in a regular supervisory conference each week. - Assume responsibility for own learning by having an agenda of items for discussion.
OUTCOME MEASURES: Student will be able:
RATING
Attend weekly supervisory conference on a regular basis.
Apply information/insight gained in supervisory
conferences to assignments and tasks.
COMMENTS:
Outcome #8
To write grammatically correct documents
(mention supervisor's appraisal).
STUDENTS ACTIVITIES/TASKS
- Review documents from case records and outlines.
- Write reports such as social history, case notes, adoptive
home study, etc.
- Accept feedback from supervisor.
OUTCOME MEASURES: Student will be able:
RATING
To write grammatically correct documents.
To complete the documentation listed above.
COMMENTS:
Outcome #9
To speak clearly, concisely, and with conviction
(mention supervisor's appraisal).
STUDENTS ACTIVITIES/TASKS
- Talk with clients, prospective clients, staff, and other relevant
persons.
- Observe how other staff talk to clients and other relevant persons.
- Accept feedback from supervisor.
OUTCOME MEASURES: Student will be able:
RATING
To speak effectively to clients, staff, and others.
To present information about the agency/services in a clear and
coherent manner.
_____ To apply constructive feedback.
COMMENTS:
Overall summary statement of student's strengths and areas for
further development.
Overall Rating
Signatures Upon Completion Signatures Upon Completion
of Contract of Evaluation
Student Date Student Date
Supervisor Date Supervisor Date
Field Coordinator Date Sample 9/04
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Last Updated August 26, 2004 by Theresa Myadze