STUDENT EVALUATION OF FIELD PLACEMENT AND FIELD INSTRUCTOR Student Date Agency Field Instructor Placement:  Foundation  Concentration Field Advisor Field Placement 1. What were the three most important competencies (knowledge, values, skills) you gained from your field experience? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. What, if anything, were barriers that got in the way of your learning? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. During this placement, what specific activities/experiences facilitated further development of your skills? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. How have you learned to use‐self awareness to increase your skills and further your professional growth? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5. How well did this placement prepare you for professional practice?  Poorly  Not very well  Well  Very well  Extremely well 6. Would you recommend this field placement to other students?  No  Probably not  Maybe  Probably  Yes Comments ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Revised: April 12, 2011
Field Instructor Frequency (circle one) Frequency Rating Scale 1…not at all 2… seldom 3… some 4… frequently 5…very frequently 1. My field instructor explained how we could work together and discussed the kind of help s/he could provide me. 1 2 3 4 5 2. My field instructor talked with me about the knowledge, skills, and attitudes s/he would be helping to develop. 1 2 3 4 5 3. My field instructor helped me to talk about subjects that were not comfortable for me to discuss (e.g. my reactions to death and dying, sexual relationships, etc.) 1 2 3 4 5 4. When I told my field instructor how I really feel, s/he understood (e.g. my anger at a colleague, my fears about a client situations, etc.) 1 2 3 4 5 5. My field instructor helped me organize and prioritize my concerns in a situation enabling me to look at them one at a time. 1 2 3 4 5 6. My field instructor shared his/her opinions with me about the subjects we discussed, but allowed me to make my own decisions. 1 2 3 4 5 7. My field instructor created a safe atmosphere and encouraged me to discuss my mistakes and failures as well as my successes and strengths. 1 2 3 4 5 8. When I was upset about something my field instructor said or did s/he encouraged me to talk with him/her about it. 1 2 3 4 5 9. Did you have a weekly conference with your field instructor? Yes No 10. Estimate the amount of time each week you and your field instructor met for supervision: hours. 11. Estimate the amount of time each week you were given consultation and supervision by other staff in the hours. agency: 12. Did your field instructor make sure you got the experience you needed or wanted to be prepared for professional practice? 1 2 3 4 5 13. Did your field instructor assume the role of teaching during supervision? 1 2 3 4 5 Comments: _______ I give permission for the above information to be released to my Field Instructor/Task Supervisor upon request: (check one) Yes No Student Signature: ___________________________ Date _____________________ 2