George Fox University
School of Social Work
BSW Field
Paperwork
Reference Guide
For Agency Field Instructors
Table of Contents
A. BSW Internship Calendar of Important Dates
B. Professional Expectations for BSW Interns
C. Orientation Checklist
D. Intern Weekly Hour Log
E. Weekly Journal Template
F. Learning Agreement
G. MSW Supervision Monthly Log and Report Form
H. Mid-Term Evaluation Cover Sheet and Instructions
I. Progress Note Template (for Junior students only)
J. Process Recording Assignment and Template (for Senior
students only)
K. Observation of Student Form
L. Final Evaluation
M. Student Evaluation of Agency
N. Agency Evaluation of George Fox University BSW Field
Education Program
George Fox University School of Social Work
BSW Senior Field Placement Fall 2015
August 2015
8/31-9/4
Students begin internships at field placement
September 2015
9/7-9/18
Initial Site Visits held onsite at internships
 Learning Agreements to be competed by time of visit and
will be reviewed with GFU Professor.
9/22
Student Learning Agreements due to Social Work Department
9/22
First MSW Supervision form due
October 2015
10/20
Mid-Term Evaluation Due
10/27
Second MSW Supervision form due
November 2015
11/3
Senior Students Process Recording Due
11/17
Third MSW Supervision form due
December 2015
11/30-12/11 End of Semester Site Visits and Student Observations to be completed
12/8
Fourth and final MSW Supervision Form Due
12/11
Last day of internship for fall semester: Students 150 hours of field
work completed, Final Evaluations completed, all field paperwork due
to Social Work Department
12/14-12/18 George Fox University Finals Week – Students only at internship if
needed to complete 150 hour requirement or agreement made
between student and agency
George Fox University Social Work Department
BSW Senior Field Placement Spring 2016
BSW Junior Field Placement Spring 2016
January 2016
1/11
Senior students return to agencies to begin completion of final 150
hours of internship.
Junior students begin internships to complete 150 hours of
internship work.
1/18-2/5
Initial Site Visits for Junior Students held onsite at internships
 Learning Agreements to be competed by time of visit and
will be reviewed with GFU Professor.
1/26
Updated Learning Agreements due for Senior students.
1/26
1/28
First MSW Supervision form due for Senior students.
First MSW Supervision form due for Junior students.
February 2016
2/23
Second MSW Supervision form due for Senior students.
Mid-Term Evaluation due for Senior students.
2/25
Second MSW Supervision form due for Junior students.
Mid-Term Evaluation due for Junior students.
March 2016
3/7
Field Fair held at George Fox University for Agencies interested in
BSW student interns for 2016-2017 school year.
3/15
3/17
Process Recording due for Senior Students.
Progress Note due for Junior Students.
3/21-3/25
George Fox University Spring Break
3/29
3/31
Third MSW Supervision form due for Senior students.
Third MSW Supervision form due for Junior students.
April 2016
4/11-4/22
Final Site visits and Observation for Junior and Senior students.
4/19
4/21
Fourth and final MSW Supervision Form Due for Senior students.
Fourth and final MSW Supervision Form Due for Junior students.
4/22
Last day of internship for Sprint semester: Students 150 hours of field
work completed, Final Evaluations completed, all field paperwork due
to Social Work Department
4/25-2/29
George Fox University Finals Week – Students only at internship if
needed to complete 150 hour requirement or agreement made
between student and agency
** Students must turn in Internship hour logs on a weekly basis for Senior
Internships, Junior Internships, and Pre-Field hours.
** Please contact Erin Johnson, BSW Field Placement Coordinator with any
questions or concerns at ejohnson@georgefox.edu.
Professional Expectations for Social Work Students
George Fox University School of Social Work
________________________________________________________________________
Students in the School of Social Work BSW Program are required to adhere to the following
expectations, which are associated to the ability to become effective social work professionals.
Students in the School of Social Work are expected to:
1. Maintain an acceptable total GPA of 3.0 within the Bachelor of Social Work Program.
2. Demonstrate honesty and integrity by
a. Being truthful about background, experiences, and qualification
b. Completing one’s own work as original work for each assignment (no plagiarism)
3. Demonstrate behavior consistent with the NASW Code of Ethics, George Fox
University’s Student Handbook, and established laws both on and off campus.
4. Demonstrate behavior consistent with professional standards of care in agency settings,
to include reporting to agencies on time, professionally dressed as appropriate for
agency setting and standards, and ready to provide service to the organization and its
clients.
5. Demonstrate responsibility in classroom and field obligations in regards to timeliness,
attendance, completion of assignments, respectful and participatory classroom conduct,
and responsiveness to faculty recommendations for development of professionalism,
academic performance, and skill improvement.
6. Demonstrate respectful attitudes, appropriate behavior, and effective interpersonal
skills in interactions with peers, faculty, University staff, Field Agency personnel, and
clients. Students should use appropriate channels for resolving conflicts at the university
and agency settings.
7. Refrain from attending classes or agency settings under the influence of alcohol or other
mood altering substances, except where a licensed physician deems medication
necessary, prescribes it and it is taken at prescribed dosage.
8. Exhibit behavior that demonstrates respect for and avoids discrimination against any
person, group, or class on the basis of age, class, color, disability, ethnicity, gender,
material status, national origin, race, religion, and/or sexual orientation.
9. Demonstrate clear, appropriate and culturally sensitive boundaries. Refrain from
sexually harassing others; making verbal or physical threats; becoming involved in
sexual relations with clients, supervisors, or faculty; abusing others in physical,
emotional, verbal, or sexual ways; or participating in dual relationships where conflicts
of interest may exist.
Signature of Student: ____________________________
Print Name: ____________________________________
Date: __________
Orientation Checklist
George Fox University School of Social Work
_________________________________________________________________________________________________
Agency Overview
________ Review agency vision and mission/purpose statement
________ Tour of agency
________ Introductions to colleagues, support staff, and administration
________ Review organizational structure
________ Review the role of the agency in relation to the community and its resources
________ Review security and/or safety procedures and protocol
Agency Policies and Protocols
________ Review office procedures, supplies, and provisions
________ Review telephone and communication/computer utilization
________ Review intake/admissions/eligibility policy and procedures
________ Review internal communication
________ Review parking details
________ Review mileage policy
________ Review agency, department, and/or unit meeting schedule
________ Review client record/charting, policies and procedures
________ Review forms for documentation/ accountability
________ Review regulations regarding confidentiality, release of information, etc.
________ Review client fees/payment schedule
________ Review client emergency protocol
________ Review child or elder abuse reporting protocol
________ Review work schedule, including lunch and breaks
________ Review information/referral policy
________ Review agency policy regarding harassment
________ Review agency policy regarding discrimination
________ Review agency policy regarding the Americans with Disabilities Act
________ Review agency policy regarding OSHA
________ Review agency policy regarding HIPAA
________ Review
Field Instructor/Student Responsibilities
________ Review expectations for supervision and schedule
________ Review educationally based recording schedule
________ Review use of preceptor (if applicable)
________ Review plan for diversity/multi-cultural experiences
________ Review plan for monitoring of student hours (by both field instructor and student)
________ Review agency training or staff development opportunities
________ Review student’s personal safety issues and concerns and strategies to deal with them
SIGNATURES:
__________________________________________________________
Field Instructor
________________________
Date
__________________________________________________________
Student
________________________
Date
Weekly Field Internship Log
George Fox University School of Social Work
_________________________________________________________________________________________________
Name of Student: ___________________________________Date Completed: __________
Purpose: This a record of the student’s time spent at the agency internship site. Please record daily tasks and
activities in which you were engaged, the date, and the time in hours and minutes. Please use decimals to
indicate no smaller than 15-minute time slots (Examples: .25=15 minutes; .5=30 minutes, etc.). Task and MSW
supervision hours should be included here, as well as special trainings. A separate MSW Monthly Supervision
Report is to be submitted at the end of the month, but this Weekly Field Internship Log serves as the
master sheet for all hours the student completes at the field site. The MSW Monthly Supervision Report
provides detail on areas discussed and is simply further verification of the supervision requirement.
Date
Time In
Time
Out
Activities and Tasks
Daily Total
Week Total
Semester Total
***Supervisors, please confirm student’s demonstrated performance and field hours
for this week by writing your initials next to one of the following summary measures.
If you note, Needs improvement, this will initiate contact by GFU Field Faculty.
Excellent______ Meets expectations ______ Needs improvement______
Signed by Agency Supervisor ______________________________ Date __________________
Student Signature ____________________________________________________ Date _______________________
Weekly Journal Template
George Fox University School of Social Work
__________________________________________________________________________________________
1. Time and dates at the placement
2. List of activities involving direct client contact
Students should provide a list of all the activities that week that involved
direct contact with clients, i.e., telephone contacts, meetings with clients, leading, coleading groups, client observations/supervision of client activities. Students should
indicate approximate time spent on various activities.
Entry examples: Spoke to Ms. Smith via telephone (5 min)
Observed John in class (45 min)
Led self-esteem group (1 hour)
3. List of activities involving indirect client service
Students should include in this section activities, supervision, staff meetings,
seminars, contacts with other agencies, meetings with other professionals,
telephone contacts, etc.
Entry examples:
Supervision (1 hour)
Spoke with classroom teacher (20 min)
Called caseworker (10 min)
4. Progress toward learning goals
Students should include a subjective analysis of their progress, in terms of
knowledge and practice.
5. Discovered areas I need to address
Students should discuss areas of growth to focus on for the next week of
internship or on through the remainder of the semester. These areas should be
related to the student’s learning agreement and growth process.
6. Discussion of Key Topic or Issue
Students should include in this section discussion of potential or existing
value conflicts or dilemmas as they relate to their own values and ethics and those
of the profession. theoretical application, case examples, or information from
trainings.
BSW Learning Agreement
George Fox University School of Social Work
_________________________________________________________________________________________________
I. General Information:
Date: _____________________________________
Student Name: ______________________________________________________________________________________
Cell Phone: _________________________________
Field Agency Name: ________________________________________________________________________________
Program or department (if applicable)__________________________________________________________
Address: _____________________________________
Phone: __________________________________
_____________________________________
_____________________________________
Field (Task) Supervisor: ________________________________
Title: ___________________________
Email: ______________________________________________________
Phone: _________________________
MSW Supervisor: ________________________________________
Title: ___________________________
Email: ______________________________________________________
Phone: _________________________
Additional Agency Team Members:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Days and Hours of Practicum:
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
II. The Learning Agreement:
Using the Learning Agreement format, please specify learning activities and practice
experiences through which the intern may develop and demonstrate practice
behaviors associated with areas of Social Work Competency.
The Learning Agreement is a working document that can be updated throughout the
two semesters of the internship. The tasks and assignments are designed to
promote the development of practice competency through practical and concrete
engagement in tasks, projects and professional activities.
The Learning Agreement is constructed collaboratively between the field instructor
and student intern, and assisted by the field faculty. The needs of the student, as
well as the service context and agency mission inform the content of the learning
agreement. This plan for the internship provides a context for the classroom based
theoretical and practice content to be integrated in the reality of agency based social
service.
The first ten areas of competency are expectations set by the 2008 Educational
Policy and Accreditation Standards (EPAS) of the Council on Social Work Education
(CSWE); the eleventh area of competency reflects the commitment of the George Fox
School of Social Work mission to integrate faith competently and ethically with
professional social work practice.
This Learning Agreement form includes an identification of each competency, and
associated social work practice behaviors are listed. Observed practice behaviors
identified as tasks provide the evidence for the end of semester evaluation.
Competence #1: Intern identifies as a professional social worker and conducts
himself/herself accordingly.
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
Knows the profession’s history (2.1.1)
Has a commitment to enhancing the profession (2.1.1)
Has a commitment to conducting himself/herself as a
professional
social worker (EPAS 2.1.1)
Has a commitment to career-long learning and growth
(2.1.1e)
Advocates well for client access to services of social work
(2.1.1a)
Practices personal reflection and self-correction to
assure continual
professional development (2.1.1b)
Attends well to professional roles and boundaries
(2.1.1c)
Demonstrates professional demeanor in behavior
(2.1.1d)
Demonstrates professional demeanor in appearance
(2.1.1d)
Demonstrates professional demeanor in communication
(2.1.1d)
Uses supervision and consultation effectively (2.1.1f)
Task #1:
Task #2:
Task #3:
Task #4
Competence #2: Intern applies social work ethical principles to guide his or her
professional practice.
2.1
2.2
2.3
Knowledgeable about the value base of the profession
(2.1.2)
Is knowledgeable of, and abides by, the ethical standards
of the profession. (2.1.2)
Is knowledgeable of, and abides by laws relevant to
social work (2.1.2)
Task #1:
Task #2:
Task #3:
2.4
2.5
Recognizes and manages personal values in a way that
allows professional values to guide practice (2.1.2a)
Applies standards of the NASW Code of Ethics and, as
applicable, of the International Federation of Social
Workers (2.1.2b)
2.6
Tolerates well ambiguity in resolving ethical conflicts
(2.1.2c)
2.7
Is able to apply strategies of ethical reasoning to arrive
at principled decisions (2.1.2d)
Task #4
Competence #3: Intern applies critical thinking to inform and communicate
professional judgments.
3.1
3.2
3.3
3.4
3.5
3.6
3.7
Is knowledgeable about the principles of logic and
scientific inquiry, and reasoned discernment (2.1.3)
Uses critical thinking augmented by creativity and
curiosity (2.1.3)
Synthesizes and communicates relevant information in
practice (2.1.3)
Is skilled at appraising and integrating multiple sources
of knowledge; including research-based knowledge and
practice wisdom (2.1.3a)
Is skilled at analyzing models of assessment, prevention,
intervention, and evaluation (2.1.3b)
Demonstrates effective oral communication in working
with individuals, families, groups, organizations,
communities, and colleagues (2.1.3c)
Demonstrates effective written communication in
working with individuals, families, groups,
organizations, communities, and colleagues (2.1.3c)
Task #1:
Task #2:
Task #3:
Task #4
Competence #4: Intern engages diversity and difference in practice.
4.1
4.2
4.3
4.4
4.5
4.6
Treats diverse clients with dignity and respect (2.1.4)
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
orientation (2.1.4)
Recognizes the extent to which a culture’s structures and
values may oppress, marginalize, alienate, or create or
enhance privilege and power (2.1.4a)
Has sufficient self-awareness to eliminate the influence of
personal biases and values in working with diverse groups
(2.1.4b)
Recognizes and communicates her or his understanding of
the importance of difference in shaping life experiences
(2.1.4c)
Views herself or himself as a learner and engages those he
or she works with as informants (2.1.4d)
Task #1:
Task #2:
Task #3:
Task #4
Competence #5: Intern advances human rights and social and economic justice
5.1
5.2
5.3
5.4
5.5
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 education
(2.1.5)
Recognizes the global interconnections of
oppression and is knowledgeable about
theories of justice and strategies to promote
human and civil rights (2.1.5)
Understands the forms and mechanisms of
oppression and discrimination (2.1.5a)
Task #1:
Task #2:
Task #3:
Task #4
Is skilled at advocating for human rights and
social and economic justice (2.1.5b)
Is skilled at engaging in practices that advance
social and economic justice (2.1.5c)
Competence #6: Intern engages in research-informed practice and practiceinformed research.
6.1
Is skilled at using practice experience to inform
research (2.1.6a)
Task #1:
6.2
Is skilled at employing evidence-based
interventions (2.1.6b)
Task #2:
6.3
Is skilled at evaluating her or his practice
(2.1.6)
Task #3:
6.4
6.5
Is skilled at using research findings to improve
practice, policy, and social service delivery
(2.1.6)
Comprehends quantitative research (2.1.6)
6.6
Comprehends qualitative research (2.1.6)
6.7
Understands scientific and ethical approaches
to building knowledge (2.1.6)
Task #4
Competence #7: Intern applies knowledge of human behavior and the social
environment.
7.1
7.2
7.3
7.4
7.5
7.6
Is knowledgeable about human behavior across
the life course (2.1.7)
Is knowledgeable about the range of social
systems in which people live
Is knowledgeable about the ways social systems
promote or deter people in maintaining or
achieving health and well-being (2.1.7)
Is skilled at applying theories and knowledge
about biological variables, social variables,
cultural variables, psychological variables, and
spiritual development (2.1.7)
Uses conceptual frameworks to guide the
processes of assessment, intervention, and
evaluation (2.1.7a)
Task #1:
Task #2:
Task #3:
Task #4
Critiques and applies knowledge to understand
person and environment (2.1.7b)
Competence #8: Intern engages in policy practice to advance social and economic
well-being and to deliver effective social work services.
8.1
8.2
8.3
8.4
8.5
8.6
8.7
Is skilled at collaborating with colleagues and
clients for effective policy action (2.1.8b)
Understands that policy affects service
delivery (2.1.8)
Actively engages in policy practice (2.1.8)
Is knowledgeable about the history of social
policies and services (2.1.8)
Is knowledgeable about current social policies
and services (2.1.8)
Is knowledgeable about the role of practice in
policy development (2.1.8)
Is skilled at analyzing, formulating, and
advocating for policies that advance social
well-being (2.1.8a)
Task #1:
Task #2:
Task #3:
Task #4
Competence #9: Intern responds to contexts that shape practice.
9.1
9.2
9.3
9.4
Is informed, resourceful, and proactive in
responding to evolving organizational, community,
and societal contexts at all levels of practice (2.1.9)
Recognizes that the context of practice is dynamic,
and has the knowledge and skills to respond
proactively (2.1.9)
Is skilled at continuously discovering, appraising,
and attending to changing locales, populations,
scientific and technological developments, and
emerging societal trends in order to provide
relevant services (2.1.9a)
Is skilled at providing leadership in promoting
sustainable changes in service delivery and practice
to improve the quality of social services (2.1.9b)
Task #1:
Task #2:
Task #3:
Task #4
Competence #10:
Intern engages, assess, intervenes and evaluates with
individuals, families, groups, organizations and communities.
10.1
10.2
10.3
10.4
10.5
10.6
10.7
10.8
10.9
10.10
10.11
10.12
10.13
10.14
10.15
10.16
10.17
10.18
10.19
Is skilled at identifying, analyzing, and
implementing evidence-based interventions
designed to achieve client goals (2.1.10)
Is skilled at using research and technological
advances (2.1.10)
Is skilled at evaluating program outcomes
(2.1.10)
Is skilled at evaluating the effectiveness of her
or his practice (2.1.10)
Is skilled at developing, analyzing, advocating,
and providing leadership for policies and
services (2.1.10)
Is skilled at promoting social and economic
justice (2.1.10)
Engagement Practice Behaviors (EP
2.1.10a). The student:
Prepares for action with individuals, families,
groups, organizations, and communities
(2.1.10 a-1)
Uses empathy and other interpersonal skills
(2.1.10 a-2)
Develops mutually agreed-on focus of work
and desired outcomes with clients (2.1.10 a-3)
Assessment Practice Behaviors (EP 2.1.10b).
The student:
Collects, organizes, and interprets client data
(2.1.10 b-1)
Assesses client strengths and limitations
(2.1.10 b-2)
Develops mutually agreed-on intervention
goals and objectives (2.1.10b-3)
Selects appropriate intervention strategies
(2.1.10 b-4)
Intervention Practice Behaviors (2.1.10 c).
The student:
Initiates actions to achieve organizational
goals (2.1.10 c-1)
Implements prevention interventions that
enhance client capacities (2.1.10 c-2)
Helps clients resolve problems (2.1.10 c-3)
Negotiates, mediates, and advocates for clients
(2.1.10 c-4)
Facilitates transitions and endings (2.1.10 c-5)
Evaluation Practice Behaviors (EP 2.1.10 d).
The student:
Critically analyzes, monitors, and evaluates
interventions (2.1.10 d)
Task #1:
Task #2:
Task #3:
Task #4
Competence #11: Intern demonstrates skills and knowledge for social work
practice that are spiritually informed and that recognize religious contexts.
Social workers demonstrate knowledge about the role
of spirituality and religion in social work practice.
(EP 2.1.7 a, b).
Social workers are able to incorporate knowledge
about the role of religion and spirituality when
working with individuals, families, groups,
organizations, and communities.
(EP 2.1.4 a, c; 2.1.7 a, b)
Attentive to ways others (e.g. clients, co-workers,
supervisors, other helpers) express spiritual and
religious matters and concerns (EP 2.1.4 a, c).
Understands guidelines for appropriate integration of
faith and practice in agency context (EP 2.1.2 a)
Follows guidelines for appropriate integration of faith
and practice in agency context (EP 2.1.2 a).
Task #1:
Task #2:
Task #3:
Task #4
III. Signatures:
Student: ______________________________________________________________
Date: ______________
Field (Task) Supervisor: __________________________________________
Date: ______________
GFU Faculty Field Liaison: ________________________________________
Date: ______________
GFU Director of Field Education: _________________________________
Date: ______________
Monthly Supervision Log
George Fox University School of Social Work
_________________________________________________________________________________________________
Name of Student: ___________________________________Month: ______________________
Dates and times of supervision:
Date
Start
Time
End
Time
Individuals Present
Month Total
Semester Total
Student Signature: ______________________________
Date: __________________
Field Instructor Signature: _______________________ Date: __________________
Daily Total
Student Supervision Report Form
George Fox University School of Social Work
_________________________________________________________________________________________________
Each supervision session students should complete this form to prepare for the
supervision session and to reflect on issues discussed in supervision. At the end of
the month the student will attach them to the cover page log and submit the signed
copies to the field faculty.
Session #
Date:
Prior to Supervision Session:
Identify 2- 3 issues that are areas of concern, growth, and development you
wish to discuss in supervision this week.
If you have specific questions about a case, theory, ethical dilemma, or other
area of practice, please write them here (attending to confidentiality
guidelines of the agency and the School of Social Work.)
Reflection on supervision session:
What are your top 2-3 learning points you have taken away from this session?
What are areas of focus for future supervision session?
Student Signature: __________________________
Date: _________________
Progress Note for Field Practicum
George Fox University School of Social Work
__________________________________________________________________________________________
Student______________________________
Date ________________________________
Learning Agreement Task Addressed:
Situational Context:
Persons Present
Location
Purpose
Your Role:
Briefly describe learning situation:
What theoretical information, knowledge of population or culture, etc., can you
identify within this situation?
Describe personal change:
Questions/areas for further study which arise from this situation:
Process Recording
George Fox University School of Social Work
_________________________________________________________________________________________________
Student Name: _______________________________
Date: _________________
INTRODUCTION: Human interactions are complex. There are many simultaneous
events going on in all participants of a conversation, verbally, visibly, and within
each person. All are important aspects of communication. In a helping relationship,
it is important that the responses of the helper be intentional and effective in
supporting the communication of the other. In order to achieve this goal, it is
critical to reflect upon conversations, to go over them and ponder the elements in
order to gain insight that will enhance self-knowledge and skill. Often written
process recordings are used in supervisory sessions as an alternative to audio
recording or videotaping. They may also provide a useful journaling format for
professional review and planning and for self-exploration and personal growth.
TERMS:
Process Recording: Written documentation of interpersonal event for purpose of
learning and supervision.
Situational Context: Brief description of event environment.
Verbatim: Verbal and non-verbal observed content in script format. Description of
what happened exactly in auditory, visual, tactile, and olfactory modes. Intensity of
volume or gestures can be noted in parentheses.
Internal Dialog: Affective content of recorder’s thoughts and considerations during
event corresponding to verbatim at bio-psycho-social-spiritual spheres. This may
involve the recorder’s own experiences, anxieties, biases or values that are brought
to light by the conversation.
Discussion: Post-event and post-recording reflection by recorder upon observed
and affective content.
Supervisory Comments: Insights shared through dialog with supervisor or
colleague.
Situational Context:
1. Client’s general information (initials or different name, gender, age, etc.) –
always protect confidentiality.
2. Identify persons present and roles of persons present at the session (include
yourself).
3. The number of the session (e.g., 3rd contact with JC)
4. Purpose of meeting/ goals being addressed:
Verbal and Non-Verbal Dialog:
Internal Dialog/Observation:
Student Reflection:
Supervisor Signature: ______________________________
Date: ____________
Student Signature: _________________________________
Date: ____________
Supervisor Comments:
Mid-Term Evaluation of Student Intern
Performance in Field Placement
George Fox University School of Social Work
_________________________________________________________________________________________________
A. Now, at mid-term, the social work student intern and field instructor
review the current learning agreement established at the start of the
semester. Make comments in the margin on the learning agreement that
indicate tasks that have been completed, are in process, and will be
addressed by the semester’s end. Once the review is completed the
learning agreement is attached to this form.
B. The field instructor and student discuss each area of competency and
mark the student’s current level of skill development. A number
representing the skill level chosen should be written next to each area of
competency.
Skill Level Development:
1. Concerns present – Significant concerns are present in relation to the student’s
skill level in this area. These concerns have been brought to the attention of the
student and a remediation plan has been activated.
2. Needs Attention – The student needs to focus on this area of competence due to
the absence of opportunities to develop in this area. The student needs more
time, practice and supervision to develop in this area.
3. Beginning – The student is beginning to show an understanding of this area of
competence and has beginning practice skills in this area.
4. Progressing – The student is developing the skills in the area and understands
concepts related to the competency. The student’s performance may need more
practice and development, yet is acceptable at this time.
Competencies:
1) ________ Identify as a professional social worker and conduct oneself accordingly.
2) ________ Apply social work ethical principles to guide professional practice.
3) ________ Apply critical thinking to inform and communicate professional
judgments.
4) ________ Engage diversity and difference in practice.
5) ________ Advance human rights and social and economic justice.
6) ________ Engage in research-informed practice and practice-informed research.
7) ________ Apply knowledge of human behavior and the social environment.
8) ________ Engage in policy practice to advance social and economic wellbeing and to deliver effective social work services.
9) _________ Respond to contexts that shape practice.
10)________ Engage, assess, intervene, and evaluate with individuals, families,
groups, organizations, and communities.
11)________ Intern demonstrates skills and knowledge for social work practice
that are spiritually informed and that recognize religious contexts.
C. After discussing the student’s learning agreement and the student’s
current level of skill development the field instructor should complete to
following and discuss with the student.
Please check one of the following:
________ This intern is excelling in field placement by performing above expectations for
interns at the mid-term evaluation mark.
________ This intern is meeting the expectations of a field intern at the mid-term.
________ This intern is functioning somewhat below the expectations of a field intern at midterm.
________ This intern is functioning below the expectations of a field placement intern. There
is considerable concern that the intern will not be ready for the next level of social work
practice by the end of the term. (Checking this level will indicate need for field faculty follow
up and remediation plan.
Comments/elaboration:
D. Student and supervisor sign the mid-term evaluation and the student
submits the mid-term evaluation to the field faculty for review and
documentation.
Student Signature: __________________________________________
Date: ___________________________
Signature of Evaluator: _____________________________________
Date: ___________________________
Observation of Student in Field Placement
George Fox University School of Social Work
_________________________________________________________________________________________________
Student Name______________________________________ Date ___________________
Agency_____________________________ Observer ______________________________
Observation of student in Field Related Practice
Activity Observed
Appropriate methods and skills demonstrated by student:
Areas of strength exhibited by student:
Areas for further development and growth:
Student Signature: __________________________________ Date: ___________
Observer’s Signature: _______________________ _______ Date: ___________
BSW Supervisor Evaluation of Student Intern
George Fox University School of Social Work
_________________________________________________________________________________________________
Student:
Agency:
Field Instructor:
Liaison:
Date of Evaluation:
Please place an “X” in the appropriate boxes:
Top of Form
SWRK 475
SWRK 476
SWRK 477
Introduction
The George Fox University Undergraduate Social Work Program is accredited by the
Council on Social Work Education (CSWE). “In social work, the signature pedagogy
is field education. The intent of field education is to connect the theoretical and
conceptual contribution of the classroom with the practical world of the practice
setting. It is a basic precept of social work education that the two interrelated
components of curriculum—classroom and field—are of equal importance within
the curriculum, and each contributes to the development of the requisite
competencies of professional practice. Field education is systematically designed,
supervised, coordinated, and evaluated based on criteria by which students
demonstrate the achievement of program competencies” (CSWE, EPAS, 2012, p. 8).
To that end, this evaluation is used to facilitate assessment of the student’s
acquisition of practice behaviors and overall competence for beginning generalist
practice.
1
2
3
4
5
Developing—Does not demonstrate competency.
Novice—Demonstrates beginning level competency.
Competent—Demonstrates competency.
Proficient—Demonstrates advanced competency.
Excellent—Demonstrates mastery of competency.
Please mark the number that most closely reflects your evaluation of student ability for each area
indicated on the following pages.
Proficient
Excellent
1.5
1.6
Competent
1.3
1.4
Advocates for client access to services of social work (2.1.1a)
Practices personal reflection and self-correction to assure continual
professional development (2.1.1b)
Attends well to professional roles and boundaries (2.1.1c)
Demonstrates professional demeanor in behavior, demeanor, and communication
(2.1.1d)
Engages in career-long learning (2.1.1e)
Uses supervision and consultation (2.1.1f)
Comments:
Novice
1.1
1.2
Developing
Competence #1: Intern identifies as a professional social worker and conducts himself/herself accordingly.
Practice Behaviors
1
1
2
2
3
3
4
4
5
5
1
1
2
2
3
3
4
4
5
5
1
1
2
2
3
3
4
4
5
5
Proficient
Excellent
2.3
2.4
Competent
2.2
Recognizes and manages personal values in a way that allows professional
values to guide practice (2.1.2a)
When making ethical decisions the intern applies standards of the NASW Code
of Ethics and, as applicable, of the International Federation of Social Workers.
(2.1.2b)
Tolerates well ambiguity in resolving ethical conflicts (2.1.2c)
Is able to apply strategies of ethical reasoning to arrive at principled decisions
(2.1.2d)
Comments:
Novice
2.1
Developing
Competence #2: Intern applies social work ethical principles to guide his or her professional practice.
Practice Behaviors
1
2
3
4
5
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
Proficient
Excellent
3.3
Competent
3.2
Is skilled at distinguishing, appraising and integrating multiple sources of
knowledge; including research-based knowledge and practice wisdom (2.1.3a)
Is skilled at analyzing models of assessment, prevention, intervention, and
evaluation (2.1.3b)
Demonstrates effective oral and written communication in working with
individuals, families, groups, organizations, communities, and colleagues
(2.1.3c)
Novice
3.1
Developing
Competence #3: Intern applies critical thinking to inform and communicate professional judgments.
Practice Behaviors
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
4.4
Excellent
4.3
Proficient
4.2
Recognizes the extent to which a culture’s structures and values may oppress,
marginalize, alienate, or create or enhance privilege and power (2.1.4a)
Has sufficient self-awareness to eliminate the influence of personal biases and
values in working with diverse groups (2.1.4b)
Recognizes and communicates their understanding of the importance of
difference in shaping life experiences (2.1.4c)
Views themselves as a learner and engages those with whom they work as
informants (2.1.4d)
Comments:
Competent
4.1
Novice
Competence #4: Intern engages diversity and difference in practice.
Practice Behaviors
Developing
Comments:
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Competent
Proficient
Excellent
5.2
5.3
Understands the forms and mechanisms of oppression and discrimination
(2.1.5a)
Is skilled at advocating for human rights and social and economic justice (2.1.5b)
Is skilled at engaging in practices that advance social and economic justice
(2.1.5c)
Novice
5.1
Developing
Competence #5: Intern advances human rights and social and economic justice.
Practice Behaviors
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
Comments:
Competent
Proficient
Excellent
Uses practice experience to inform scientific inquiry (2.1.6a)
Uses research evidence to inform practice (2.1.6b)
Comments:
Novice
6.1
6.2
Developing
Competence #6: Intern engages in research-informed practice and practice-informed research.
Practice Behaviors
1
1
2
2
3
3
4
4
5
5
Competent
Proficient
Excellent
7.2
Uses conceptual frameworks to guide the processes of assessment, intervention,
and evaluation (2.1.7a)
Critiques and applies knowledge to understand person and environment (2.1.7b)
Comments:
Novice
7.1
Developing
Competence #7: Intern applies knowledge of human behavior and the social environment.
Practice Behaviors
1
2
3
4
5
1
2
3
4
5
Novice
Competent
Proficient
Excellent
4
5
1
2
3
4
5
Excellent
9.2
Is skilled at continuously discovering, appraising, and attending to changing
locales, populations, scientific and technological developments, and emerging
societal trends in order to provide relevant services (2.1.9a)
Is skilled at providing leadership in promoting sustainable changes in service
delivery and practice to improve the quality of social services (2.1.9b)
Comments:
3
Proficient
9.1
2
Competent
Competence #9: Intern responds to contexts that shape practice.
Practice Behaviors
1
Novice
8.2
Is skilled at analyzing, formulating, and advocating for policies that advance
social well-being (2.1.8a)
Is skilled at collaborating with colleagues and clients for effective policy action
(2.1.8b)
Comments:
Developing
8.1
Developing
Competence #8: Intern engages in policy practice to advance social and economic well-being and to deliver
effective social work services.
Practice Behaviors
1
2
3
4
5
1
2
3
4
5
10.10
10.11
10.12
10.13
Excellent
10.8
10.9
Proficient
10.4
10.5
10.6
10.7
Competent
10.2
10.3
Engagement Practice Behaviors (EP 2.1.10a). The intern:
Prepares for action with individuals, families, groups, organizations, and
communities (2.1.10 a-1)
Uses empathy and other interpersonal skills (2.1.10 a-2)
Develops mutually agreed-on focus of work and desired outcomes with
clients (2.1.10 a-3)
Assessment Practice Behaviors (EP 2.1.10b). The intern:
Collects, organizes, and interprets client data (2.1.10 b-1)
Assesses client strengths and limitations (2.1.10 b-2)
Develops mutually agreed-on intervention goals and objectives (2.1.10b-3)
Selects appropriate intervention strategies (2.1.10 b-4)
Intervention Practice Behaviors (2.1.10 c). The intern:
Initiates actions to achieve organizational goals (2.1.10 c-1)
Implements prevention interventions that enhance client capacities (2.1.10 c2)
Helps clients resolve problems (2.1.10 c-3)
Negotiates, mediates, and advocates for clients (2.1.10 c-4)
Facilitates transitions and endings (2.1.10 c-5)
Evaluation Practice Behaviors (EP 2.1.10 d). The intern:
Critically analyzes, monitors, and evaluates interventions (2.1.10 d)
Comments:
Novice
10.1
Developing
Competence #10: Intern engages, assesses, intervenes and evaluates with individuals, families, groups,
organizations, and communities.
Practice Behaviors
1
2
3
4
5
1
1
2
2
3
3
4
4
5
5
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
5
5
5
5
1
1
2
2
3
3
4
4
5
5
1
1
1
2
2
2
3
3
3
4
4
4
5
5
5
Excellent
11.4
Proficient
11.3
Competent
11.2
Demonstrates knowledge about role of spirituality and religion in social work
practice (EP 2.1.7 a, b).
Able to incorporate knowledge about the role of religion and spirituality when
working with individuals, families, groups, organizations, and communities (EP
2.1.4 a, c; 2.1.7 a, b)
Recognizes and manages how Christian worldview and values can guide
professional social work practice.
Critically analyzes how Christian spiritual and/or religious traditions assist or
hinder the helping process.
Novice
11.1
Developing
Competence # 11: Intern demonstrates skills and knowledge for social work practice that are spiritually
informed and that recognize religious contexts.
Practice Behaviors
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
11.5
11.6
11.7
Attentive to ways others (e.g. clients, co-workers, supervisors, other helpers)
express spiritual and religious matters and concerns and respects the
contribution of other traditions to healing and wholeness of individuals (EP
2.1.4 a, c).
Understands guidelines for appropriate integration of faith and practice in
agency context (EP 2.1.2 a)
Follows guidelines for appropriate integration of faith and practice in agency
context (EP 2.1.2 a).
Comments:
1
2
3
4
5
1
2
3
4
5
1
2
3
4
FINAL OVERALL EVALUATION:
Please check one of the following at the final evaluation. At the midterm evaluation do NOT complete
this section.
Top of Form
This intern has excelled in field placement by performing above expectations for interns. 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.
This intern has met the expectations of the field placement. This intern is ready for beginning level
social work practice.
This intern is not yet ready for beginning level social work practice.
This intern is not yet ready for beginning level social work practice, and has demonstrated serious
problems in performance, and perhaps should be encouraged to pursue another major.
Comments/elaboration:
Task Supervisor: _____________________________________________________________
Date: ____________________
Student: _______________________________________________________________________
Date: ____________________
GFU Field Faculty: ____________________________________________________________
Date: ____________________
BSW Field Coordinator: ______________________________________________________
Date: ____________________
5
Student Evaluation of Field Education Program
George Fox University School of Social Work
_________________________________________________________________________________________________
Student Name: _________________________________________________________________________
Agency: _________________________________________________________________________________
Field Instructor (MSW): _____________________________________________________________
Agency Contact: _______________________________________________________________________
Faculty Liaison: _______________________________________________________________________
1. Rate the overall quality of your intern experience with this agency.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
2. To what degree have you been able to develop and practice skills and competencies?
Highest Rating
6
Please describe:
5
4
3
2
1
Lowest Rating
3. Rate your everyday supervision and contact with staff.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
4. Rate your formal MSW supervision sessions. How were they helpful to you?
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
5. Rate the involvement of your field faculty and its helpfulness to you.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
6. Rate this placement in helping you accomplish professional learning goals.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
Please make specific suggestions of how this agency experience might be improved.
Agency Evaluation of BSW Field Education Program
George Fox University School of Social Work
_________________________________________________________________________________________________
Supervisor: _____________________________________________________________
Agency: _________________________________________________________________________________
Agency Contact: _______________________________________________________________________
Field Faculty: _______________________________________________________________________
Student Name: _________________________________________________________________________
1. Rate the overall quality of your experience with this student intern.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
2. To what degree has the student intern been able to support and further the work of the
agency?
Highest Rating
6
Please describe:
5
4
3
2
1
Lowest Rating
3. Rate the student’s level of preparation for daily work at the internship.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
4. Rate the level of your satisfaction with the training you received/were offered from the
School of Social Work in preparation for your role as a Supervisor.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
5. Rate the involvement of the student’s field faculty and its helpfulness to you.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
6. Rate the overall quality of your experience with the School of Social Work Field
Education Program at George Fox University.
Highest Rating
6
5
4
3
2
1
Lowest Rating
Please describe:
Please make specific suggestions of how this field internship experience might be
improved.
Please email a copy of your evaluation to the following:
Field Instructors for BSW Student: Erin Johnson at ejohnson@georgefox.edu