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 use 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 assess organization's structures and service delivery system and
contribute to organizational change.
STUDENT ACTIVITIES/TASKS
- Assess an aspect of the organization and service delivery system.
- Participate in activities aimed at improving organizational
functioning and service delivery.
OUTCOME MEASURES: Student will be able:
RATING
To assess the program and identify areas of needed change.
To contribute in improving organizational functioning and
service delivery.
COMMENTS:
Outcome #2
To use theoretical frameworks to explain interaction between
individuals, organizations, and communities.
STUDENTS ACTIVITIES/TASKS
- Select at least one theoretical framework (from classes/readings)
and discuss with supervisor how it may explain the interactions
between individuals, organizations, and communities.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate an understanding of how theories may help to
explain interactions between individuals, organizations, and
communities.
COMMENTS:
Outcome #3
To identify and assess situations on the community level using
generalist practice knowledge.
STUDENT ACTIVITIES/TASKS
- Review situations within the community which can impact on
clients.
- Identify services available in the community to deal with
community issues.
OUTCOME MEASURES: Student will be able:
RATING
To comprehend a historical background on an issue
and the results on clients.
To identify a specific community issue and how
that issue impacts on a specific client using generalist
practice knowledge.
COMMENTS:
Outcome #4
To develop intervention plans that meet clients' needs
(community and/or organizational) while maintaining the Code of
Ethics for social work practice.
STUDENTS ACTIVITIES/TASKS
- Attend supervisory review(s); etc.
- Attend annual reviews, special meetings (________).
OUTCOME MEASURES: Student will be able:
RATING
To prepare case plans in preparation for special
meetings.
To experience the means of assessing the kind and
quality of services being provided on cases.
COMMENTS:
Outcome #5
To evaluate one's own practice interventions
(applying knowledge from research classes).
STUDENTS ACTIVITIES/TASKS
- Develop methods to evaluate the effectiveness of your interventions
based on knowledge you have obtained from your research classes.
OUTCOME MEASURES: Student will be able:
RATING
To apply research strategies to determine the effectiveness of
their interventions.
COMMENTS:
Outcome #6
To apply strategies of empowerment, advocacy, and social change to
advance social and economic justice.
STUDENTS ACTIVITIES/TASKS
- Review the agency's training on cultural diversity as it
relates to personnel and clients.
- Identify "at risk" issues of primary assigned cases.
- Identify ways to empower, advocate on behalf of, and encourage
social change for "at risk" populations.
OUTCOME MEASURES: Student will be able:
RATING
To enhance and/or enlighten knowledge about
"at risk" populations and special needs of that
population.
To understand the agency's approach to cultural
diversity in relation to personnel and clients.
To relate to differences of staff and clients.
_____ To empower and advocate on behalf of "at risk" populations to
advance social and economic justice.
COMMENTS:
Outcome #7
To be able to utilize less supervision and more professional
judgement.
STUDENTS ACTIVITIES/TASKS
- Meet formally with supervisor once a week.
OUTCOME MEASURES: Student will be able:
RATING
To assist in the training of a new unit staff member,
assisting that worker in managing a caseload.
To ask questions or make suggestions that will provide
encouragement and valuable feedback.
COMMENTS:
Outcome #8
To write clearly and be able to distinguish between objective
information and subjective judgement.
STUDENTS ACTIVITIES/TASKS
- Complete all required paperwork on assigned caseload.
OUTCOME MEASURES: Student will be able:
RATING
To complete agency documentation in accordance with
agency's procedure as well as state and federal
mandates.
To have appropriate written communication skills.
COMMENTS:
Outcome #9
To apply critical thinking skills within the context of professional
social work practice (focus on critical practice issues).
STUDENTS ACTIVITIES/TASKS
- Identify critical practice issue(s) and discuss with supervisor how
they may be addressed.
OUTCOME MEASURES: Student will be able:
RATING
To demonstrate critical thinking skills by describing important
practice issues and discussing how they may be resolved.
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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