ࡱ> U ,bjbjnn 4aa%$i 8T(p0<<<<<ppp0000000140ppppp0<<4*0"""pF<<0"p0""*T3.<4./@00p0.5P"503.53.pp"ppppp00r"pppp0pppp5ppppppppp B N: Ƶ School of Social Work Bachelor of Social Work Program Senior Year Field Practice Evaluation Faculty Liaison:_______________________________ Student:____________________________ Agency:______________________________________ Date Completed:_____________________ 5The intern is functioning above expectations for interns in this area at the time of graduation43The intern has met the expectations for interns in this area at the time of graduation21The intern has not met the expectations in this area, and there is not much expectation that the intern will meet the expectations in this area in the near futuren/aNot applicable, as the intern has not had the opportunity to demonstrate competence in this area; I have not had the opportunity to observe the students abilities in this area.5=exceeds expectations; 3=meets expectations; 1=unlikely to meet expectations Comments may be made under any competency statement, if desired. Please be sure to indicate those areas in which you think the intern is particularly strong and those areas that need improvement. This evaluation is intended to give the intern feedback about her or his performance. The agency supervisors rating of these items will not directly be used to calculate the grade that is given to the intern. The faculty supervisor/field liaison has the responsibility of assigning the grade for the course. Competency #1: Demonstrate ethical and professional behavior 1The student makes effective use of supervision54321n/a2The student practice reflects an awareness of self and the ability to use self54321n/a3The student practices personal reflection and self-correction to assure continual professional development54321n/a4The student demonstrates professional demeanor in communication54321n/a5The student demonstrates professional demeanor in time management54321n/a6Their practice is informed by professional ethics and values, which are used to resolve ethical dilemmas54321n/a7The student is knowledgeable of, and abides by, the ethical standards ofthe profession 54321n/a8The student recognizes and manages personal values in a way that allowsprofessional values to guide practice (e.g., on such issues as abortion and LGBTQ+ rights)54321n/a9The student has good problem-solving skills54321n/a10The student demonstrates effective oral communication in working with individuals, families, groups, organizations, communities, and colleagues54321n/a11The student demonstrates effective written communication in working with individuals, families, groups, organizations, communities, and colleagues54321n/aComments: Competency #2: Engage diversity and difference in practice 1The students practice reflects cultural competence in work with diverse groups 54321n/a2The student is knowledgeable and respectful of clients who differ by such factors as age, class, color, culture, disability, ethnicity, gender identity and expression, immigration status, political ideology, race, religion, sex, and sexual orientation54321n/a3The student has sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse groups54321n/a4The student recognizes and communicates their understanding of the importance of difference in shaping life experiences54321n/a5The student views themselves as a learner by engaging others and/or using supervision to address personal bias 54321n/aComments: Competency #3: Advance human rights and social, economic and environmental justice 1The student recognizes that each person, regardless of position in society, has basic human rights, such as freedom, safety, privacy, an adequate standard of living, health care and education54321n/a2The student understands the forms and mechanisms of oppression and discrimination54321n/a3The student is skilled at advocating for human rights and social and economic justice54321n/a4The student is skilled at engaging in practices that advance social and economic justice54321n/a Comments: Competency #4: Engage in practice- informed research and research- informed practice 1The student demonstrates the ability to gather and analyze data to evaluate the need for, and to createchange 54321n/a2The student uses practice experience to raise questions for research/data gathering54321n/a Comments: Competency #5: Engage in policy practice 1The student actively engages in policy practice54321n/a2The student is skilled at analyzing, formulating, and advocating for policies that advance social well-being54321n/a3The student is skilled at collaborating with colleagues and clients for effective policy action54321n/a4The student understands that policy affects service delivery54321n/a5The student is knowledgeable about current social policies and services54321n/a Comments: Competency #6: Engagement with individuals, families, groups, organizations & communities 1The student demonstrates appropriate empathy with individuals, families and/or small groups54321n/a2The student demonstrates appropriate empathy with communities and/or organizations54321n/a3The student is skilled at engaging (developing a positive relationship) with individuals, families and/or small groups54321n/a4The student is skilled at engaging organizations and/or communities 54321n/a Comments: Competency #7: Assessment of individuals, families, groups, organizations & communities 1The student understands strengths and challenges in individuals, families and/or small groups54321n/a2The student understands strengths and challenges in communities and/or organizations54321n/a3The student is skilled at assessing individuals, families and/or small groups54321n/a4The student is skilled at assessing communities and/or organizations54321n/a Comments: Competency #8: Intervene with individuals, families, groups, organizations & communities 1The student provides effective services to individuals, families and/or small groups54321n/a2The student provides effective services to communities and/or organizations54321n/a3The student empowers individuals, families and/or small groups to advocate/problem-solve on their own behalf54321n/a4The student empowers communities and/or organizations to advocate/problem-solve on their own behalf54321n/a5The student terminates effectively with clients54321n/a6The student terminates effectively with the agency and colleagues54321n/a Comments: Competency #9: Evaluate practice with individuals, families, groups, organizations & communities 1The student can gather, use and analyze evidence to evaluate their practice54321n/a2The student can identify outcomes for programs in which he or she works54321n/a3The student is skilled at evaluating programs using outcomes54321n/a Comments: Additional comments on students practice skills (engagement, assessment, intervention and evaluation): OVERALL READINESS FOR ENTRY LEVEL BSW PRACTICE Please check one of the following. For example, If an appropriate position were open at this agency, for a beginning level social worker, this intern would be considered among the top candidates for this position. __ Overall, the student exceeds entry level readiness as a BSW practitioner. __ Overall, the student shows entry level readiness as a BSW practitioner __ Overall, the student needs to make additional progress to become a BSW practitioner* *A needs to make additional progress rating on this item requires that the faculty liaison be notified and involved in helping to develop a plan to address the students performance. Students overall strengths: Students areas for improvement: Field instructors recommended grade in field: __Satisfactory __Unsatisfactory __Incomplete Students Comments: SIGNATURES Student/Intern:______________________________________ Date_______________ Field Instructor:_____________________________________ Date_______________ Secondary Field Instructor:____________________________ Date_______________ Field Liaison:_______________________________________ Date_______________ All signatories should retain a copy of this evaluation. The following section should be completed by the intern: My agency supervisor and faculty supervisor have discussed this evaluation with me, and I have received a copy. My agreement or disagreement follows: I agree with the evaluation ( I do not agree with evaluation ( Interns Signature ____________________________________ Date _____________________ If the intern disagrees with the evaluation she/he/they should state that disagreement in writing and submit a copy to both the agency supervisor and the faculty supervisor. 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