California State University East Bay, Department of Social Work
(510) 885-4916 (510) 885-7580 FAX
Student Evaluation of Field Placement
Student: __________________________ Field : ________________________
Date:
______ / ______ / ______
Quarter: ____________________________
Agency:__________________________ Field Instructor:________________________
Student Classification:
Foundation Year: ______
Advanced Year: ______
Children, Youth and Families ________ Community Mental Health ________
The purpose of this form is to evaluate the field placement experience from the
student’s point of view. It will be used to gather aggregate data about the field placement program and to give feedback to the field instructors to promote the program’s
effectiveness. Please complete this form carefully and thoughtfully. Only collated data
will be shared; individual responses are confidential.
Please use the following rating scale to best describe your experience:
Poor
Fair
Good
Often
Excellent
Rarely
Once a Week ½ the Time
Regularly
1
2
3
4
5
1. My field instructor served as the primary source of instruction.
( )
2. My field liaison served as a supplementary source of instruction.
( )
3. My field instructor helped me develop a learning agreement.
( )
4. My field instructor held individual conferences with me.
( )
5. My field instructor helped me to think systematically about a case.
( )
6. The supervision was valuable to my learning.
( )
7. My field instructor required written and / or taped recordings.
( )
8. My field instructor used my recordings to teach from in our supervision.
( )
9. The evaluation process was a joint one in which both my field instructor and I
participated actively.
( )
10. My field instructor demonstrated knowledge and skills as a practitioner.
( )
Please return the completed form to the Field Director
Please use the following rating scale to best describe your experience:
Poor
Fair
Good
Often
Excellent
Rarely
Once a Week
½ the Time
2
3
1
Regularly
4
5
11. My field instructor worked effectively with students.
( )
12. My field instructor served as a professional role model for me.
( )
13. My field instructor helped me relate and apply what I learned in the classroom
to my clients in the field.
( )
14. My field instructor has met my learning needs.
( )
15. In my placement the student’s educational needs took precedence
over the agency’s services needs.
( )
16. The agency’s staff demonstrated commitment compatible with social work
values and ethics.
( )
I was given assignments working with the following:
[ ]
Individuals
[ ]
Groups
[ ]
Community
[ ]
Diverse Cultures
[ ]
Other Disciplines_______________
[ ]
[ ]
[ ]
Administrative
Gender Issues
Other MSW’s
Specifically, this year I participated in:
[ ]
Community/Task Force Involvement
[ ]
Research/Program Evaluation
[ ]
Policy Analysis or Development
[ ]
Organizing something on my own
[ ]
Sufficient number poof assignments
[ ]
Sufficient depth of assignments
[ ]
Opportunities to apply theory to field practice
I recommend this agency:
[ ]
I recommend this field instructor:
[ ]
Comments: (use a separate sheet if necessary) _______________________________
_____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________________________________________
revised 7.20.06