WRIGHT STATE UNIVERSITY

Department of Social Work

MID-POINT EVALUATION FORM

(Completed During the 1st Quarter)

Social Work 487 - Practicum in Social Work 
Instructor/Coordinator:  Dr. Theresa Myadze

Date:                                               

Name of Student:                                    

Name of Supervisor:                                 

Name of Agency:                                     

     (Address)                                      

         Phone:                                         

Evaluation Period - 
Hours Completed:                                    

Directions:  A meaningful performance evaluation must give an
accurate assessment of the student's performance in carrying 
out assignments.  As well as their ability to receive and 
actualize instructions for completing assignments.

Please use the following scales to evaluate each area:  You may
include fractions (e.g., 3.5) if they provide a more precise
indication of the student's performance.

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      Performance is frequently below expected level.
    Average

0 = Poor       Unable to perform

NA = Not       No opportunity to perform this in practicum.
   Applicable

     Demonstrates appropriate understanding of the social 
     policy and procedures that govern the agency and its 
     service delivery.

     Demonstrates a conscious disciplined use of the 
     professional self by attendance, punctuality, and 
     assignment completion, as well as thoroughness, etc.

     Demonstrates an ability to assume responsibility for own         
     learning - i.e. comes to supervision prepared to ask 
     questions and provide feedback regarding status of 
     assignments, readiness to assume additional activity, 
     etc.

     Applies knowledge gained through past experiences such as
     classroom, orientation, previous assignments, etc. to 
     current situations.

     Exercises initiative in pursuing opportunities to enhance 
     and/or further professional learning.

Identify the areas the student needs to work to enhance, prior 
to the quarter ending:







Are there new goals that have emerged as a result of this 
evaluation?  If so, please list.








Please comment on the student's observable potential as a 
"helping person."






Signatures:                                                     
           Student           Date   Supervisor             Date

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