CONCENTRATION STUDENT LEARNING AGREEMENT &
COMPETENCY EVALUATION
Student
Email
Phone Number
Agency
Unit
Unit Address
Field Instructor
Email
Phone Number
Task supervisor
Email
Phone Number
Period covered by this Learning Agreement: from__
Field Faculty
to
Email
Phone Number
As part of the Learning Agreement, please specify the following:
Student’s Work Schedule (include days and hours, coverage in field instructor’s absence, make up
arrangements for student absences:
MSW Supervision (include days, times, and with whom):
1
Instructions for completing this combined learning agreement and competency evaluation document:
The UNC-CH, School of Social Work recommends that the student’s learning agreement and competency
evaluation be completed in discussion between the field instructor and the student in consultation with
the field faculty member. The learning agreement is a dynamic teaching and learning tool that specifies
the areas of learning each field experience should provide. It brings together the contributions of the
classroom instructor, student, field instructor and field faculty member. The learning agreement has a
direct relationship to the student’s course work and the learning opportunities available at his/her field
site. The learning agreement should be developed by the student, in consultation with the field
instructor/task supervisor, after identifying the learning opportunities the agency offers. Concurrent
students should complete the learning agreement by the sixth week of placement and block placement
students by the end of the second week of placement. The learning agreement is in place for the
duration of the student’s placement. The form must be entered on-line. The field instructor, task
supervisor (if applicable), student, and field faculty member should complete appropriate sections. All
must sign the learning agreement and evaluation electronically. The learning agreement and
competency evaluations become part of the student’s permanent academic record. Both student and
field instructor should keep a printed copy of this document.
Organization: There are nine Core Competencies. Within each competency are 2 to 5 Indicators. For
each indicator are suggested Learning Activities. Competency evaluations for both SOWO 820 and
SOWO 821 are included on this combined document.
Learning Agreement Development
Begin the document by completing the front page, which includes identifying information, supervision
arrangements, and a work schedule for the student. Review the competencies and indicators on the
subsequent pages; these represent the school’s expectations regarding achievable outcomes during
placement. Consider the suggested learning activities for each indicator and check those that are
available in the agency (either DP, CMPP, or both), which will help the student accomplish the
prescribed competencies. Each indicator has two “other” boxes. This is an optional area to add
appropriate activities that may not be in the list of suggested learning activities.
The learning agreement is documentation of the planned learning experience during the student’s
practicum. It should be viewed as a dynamic document that can be changed as the practicum proceeds.
Major changes should be reviewed by the field faculty member prior to the student making changes in
the document.
The learning agreement should be reviewed at least monthly by the student, field instructor and task
supervisor. Monthly reports should report the student’s progress in applying the indicators of the
competencies.
2
Field Competency Evaluation Grading Criteria
A Competency Evaluation is required at the end of each semester/summer session in which the student
has registered for field education. In the Evaluation the field instructor/task supervisor and student will
provide ratings of the student’s competency for each indicator of each competency. The rating should
reflect the student’s competency relative to where they are in the program (e.g. first semester vs.
second semester). The rating scale for this form ranges from the need for significant improvement to
exceptional mastery, as described below:
1. Unsatisfactory – student does not have command of essential knowledge and/or does not
understand the application of knowledge to practice.
2. Limited Competence – Student demonstrates limited understanding of essential knowledge
and/or the application of knowledge to practice.
3. Emerging Competence - Student understands the skill and demonstrates a growing ability to
apply knowledge to practice.
4. Competence - Student understands and can assess the applicability of the skill and
demonstrates the skill regularly in practice.
5. Excellence - Student readily adapts the skill to the setting and demonstrates mastery of the skill
in novel, diverse and difficult contexts.
N/A (Not Applicable) may be appropriate in the first semester, before a student has an opportunity to
engage in an activity, but this rating would rarely be appropriate at the end of the second semester of
field. Likewise, a student may receive a rating of 1 or 2 on some indicators during the first semester
when beginning to practice new skills, but a rating of 2 on the final evaluation would indicate the
student’s lack of ability to acquire the skill level expected by the end of the placement. When a student
receives a rating of 2, 1, or N/A in an indicator during the first semester, the field instructor or task
supervisor and student must provide comments about the action plan developed to improve these areas
of competence in the final semester. If a student receives a rating of 2 or below in the final semester,
the field instructor or task supervisor and the student must provide specific comments to provide
context for the rating.
At the end of each competency (not each indicator), students will provide an example from the field
related tasks that demonstrates developing proficiency.
Following the Competency Evaluation, a grade of either P (pass), L (Limited Competence), F (fail), or IN
(incomplete) is assigned by field faculty. The grade of P indicates satisfactory competency; the grade of F
indicates unsatisfactory competency; a grade of L indicates the student is performing at a minimal or
inconsistent level. Students receiving an L in field education are required to work with the field
education office to develop a plan for future field experiences designed to improve the student’s
competency. IN means that the student withdrew during the semester or in some other way did not
complete all the requirements during the semester. If a mark of IN is given the student will develop a
contract with the field faculty member, defining when and how the work will be completed. A grade will
be assigned when the work is complete. A grade of F will be assigned if the work is not complete by the
conclusion of the contracted time period.
Responsibility for assigning the grade belongs to the field faculty member.
3
Competency 1 – Demonstrate Ethical and Professional Behavior
This student
demonstrates the
ability to:
1.1 - Understand
and appropriately
use global,
regional and
setting specific
regulations and
policies that
effect practice.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Explore ethical implications of the organization’s internal policies (e.g.
personnel and financial) as well as external policies (e.g. processes for
engaging organization and community partners in decision making).
Go to the UN Human Rights Council website to learn how the intergovernmental body strengthens the promotion and protection of human
rights around the globe. Discuss with your FI/TS how your placement
agency may or may not be impacted by international regulations and
policies.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1.2 - Demonstrate
and apply an
understanding of
professional and
personal
boundaries, selfdisclosure and
the need for
appropriate
emotional
regulation to the
practice setting.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1.3 - Effectively
utilize
Check all that
apply
DP
CMPP
☒
☒
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☐
☐
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☐
Competency Evaluation for Item 1.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss and demonstrate the appropriate use of self-disclosure with FI/TS
or other agency personnel.
Consistently display appropriate professional and personal boundaries
when interacting with FI/TS, agency personnel, and/or other community
professional & stakeholders.
Review and discuss with FI/TS agency policies related to confidentiality,
client rights and social work disclosure requirements.
Other:
Check all that
apply
DP
CMPP
☒
☒
☒
☒
☒
☒
☐
☐
☐
☐
Other:
Competency Evaluation for Item 1.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Check all that
apply
DP
CMPP
During supervision, discuss with FI values and ethical issues related to
assigned projects.
☒
☒
4
professional
supervision and
peer supervision
(as applicable),
including the
ability to receive
and
operationalize
supervisory
suggestions in a
non-defensive
manner.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1.4 Appropriately
apply ethical
decision making
models (and
other ethical
codes, as
applicable) and
the NASW Code
of Ethics to the
practice setting.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1.5 - Demonstrate
initiative in
seeking learning
opportunities
while managing
workload to
accomplish
Routinely develop agendas for supervision with prioritized needs and
articulated concerns.
During supervision, regularly ask for feedback and develop a plan for
implementation and review.
Discuss the impact of differences in identity between you and FI/TS (e.g.
gender, age, race, sexual orientation)
Discuss ambiguity and process challenges in supervision.
Other:
Other:
☒
☒
☒
☒
☒
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☒
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☐
☐
☐
☐
Competency Evaluation for Item 1.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review the NASW Code of Ethics with FI/TS and discuss how the Code
relates to the field setting.
Utilize the NASW Code of Ethics as a resource to respond to ethical
concerns at the time of occurrence and resolve appropriately with the
guidance of the FI/TS.
Other:
Check all that
apply
DP
CMPP
☒
☒
☒
☒
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☐
☐
☐
Other:
Competency Evaluation for Item 1.4
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Readily offer assistance to fellow interns, FI/TS, and others at the agency,
doing so with enthusiasm.
Complete assigned tasks within given time frames.
Dress appropriately for agency setting, exhibit timely attendance, and use
professional work habits.
Establish and maintain appropriate relationships with administrators,
staff, and colleagues.
Check all that
apply
DP
CMPP
☒
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5
assigned tasks
Other:
☐
☐
within expected
timeframes,
Other:
including:
documentation,
attendance, dress
☐
☐
and other
appropriate work
habits.
5 – Excellence
Competency Evaluation for Item 1.5
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
Check all that
This student
Select appropriate learning activities and/or add additional activities in
apply
demonstrates the
the “other” box.
ability to:
DP
CMPP
1.6 - Differentiate Discuss with FI/TS issues of confidentiality in all forms of electronic
☒
☒
appropriate from communication.
Read agency policy about the use of social media within the workplace
inappropriate
☒
☒
uses of electronic (e.g. Facebook, blogging). Have a discussion with the FI/TS about the
social media policies and expectations.
communications
Adhere to all agency mandates concerning use of email, text, and social
(e.g. email, text,
☒
☒
media.
social media,
blogging, etc.)
Other:
☐
☐
and use them as
indicated by the
Other:
☐
☐
practice setting.
5 – Excellence
Competency Evaluation for Item 1.6
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 1 –
Demonstrate Ethical and Professional Behavior:
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 1 –
Demonstrate Ethical and Professional Behavior:
6
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
7
Competency 2 –Engage Diversity and Difference in Practice
This student
demonstrates the
ability to:
2.1 - Articulate
how multiple
stigmatizing
identities
collectively affect
client systems,
organizations and
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
2.2 Understand
and appropriately
discuss the ways
in which
oppression and
privilege manifest
in institutional
policies and
practices.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
2.3 Recognize the
extent to which
Select appropriate learning activities and/or add additional activities in
the “other” box.
Research how the impact of difference may be affecting the client
system, organization, or community.
Discuss with FI the impact of race, class, culture, disability, ethnicity,
religion, gender, age, sexual orientation, socio-economic status, and
additional identities on client system, organization, and/or community
levels.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 2.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
During supervision, identify and discuss with FI patterns of possible
discrimination as they apply to services provided by the agency.
Discuss with FI the various barriers that prevent marginalized populations
from accessing services.
Discuss with FI personal experiences of oppression and/ or privilege and
their impact on practice.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 2.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Check all that
apply
DP
CMPP
Review past and current political and social events and discuss the effects
on client systems, organizations, and communities.
☐
☐
8
norms, values
and historical
structures may
marginalize
groups of people
and/or enhance
privilege or
power.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
2. 4 - Engage in
critical selfreflection to
identify and
manage how
personal values
and biases affect
practice with
diverse client
systems,
organizations and
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
2.5 - Adopt a
spirit of inquiry
when engaging
with diverse
groups in order to
better
understand the
Participate in cultural humility/ competence trainings or related activities
(e.g., readings, videos, class assignments) and discuss with FI ways to
create interventions that empower client systems, organizations, and/or
communities.
Other:
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 2.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Utilize a weekly journal to record personal reactions to client systems,
organizations and/or communities.
Identify personal values and biases that may conflict with social work
professional values and develop an appropriate plan for managing these
in practice.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 2.4
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review articles on best practices with diverse populations served by the
agency.
Learn and use ethnographic interviewing techniques in practice.
Seek interaction with client systems and/or communities that represent
diverse groups and discuss experiences with FI.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
9
experiences of
Other:
people who have
been
☐
☐
marginalized and
oppressed.
5 – Excellence
Competency Evaluation for Item 2.5
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 2 –
Engage Diversity and Difference in Practice:
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 2 –
Engage Diversity and Difference in Practice:
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
10
Competency 3 – Advance Human Rights and Social, Economic, and
Environmental Justice
This student
demonstrates the
ability to:
3.1 - Effectively
use theory to
formulate
strategies for the
promotion of
social justice and
human rights.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
3.2 - Advocate for
the human rights
and social and
economic justice
of the
marginalized and
oppressed.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Learn and apply a theory of empowerment to inform interventions with
client systems, organizations and/or communities.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 3.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Engage in social and political action related to social justice issues
relevant to clients and communities served.
Attend and participate in committee/community meetings convened to
promote social justice.
Draft a letter to the media and/or policy makers regarding an area related
to social justice.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
5 – Excellence
Competency Evaluation for Item 3.2
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 3 –
Advance Human Rights and Social, Economic, and Environmental Justice:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
activity plan should be
addressed)
Field Instructor/TS Comments:
Student comments:
11
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 3 –
Advance Human Rights and Social, Economic, and Environmental Justice:
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
12
Competency 4 –Engage in Practice-informed Research
and Research-Informed Practice
This student
demonstrates the
ability to:
4.1 - Incorporate
evidence and
knowledge into
the development
of effective
practice.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with FI/TS (and other colleagues, as appropriate) the theoretical
concepts which guide their decision-making.
Apply research from coursework to practice setting, as appropriate and
approved by FI/TS.
Use identified research with client systems, organizations, and/or
communities.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
4.2 - Understand
how research
questions guide
the selection of
research
methods.
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 4.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Have a conversation with the FI/TS about how research is used in the
practice setting (e.g. do they engage in research, how the agency
identifies instruments and interventions used, etc.).
Write three research questions and discuss with FI/TS research
methodology to respond to the questions.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
4.3 - Remain
informed about
current and
emerging
evidence and
Check all that
apply
DP
CMPP
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 4.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Provide FI/TS two recent (< 3 years old) journal articles each semester.
The articles should be research based and relevant to the placement
practice area;
Attend a continuing education offering related specifically to the agency
practice area. Present what you learned to your FI/TS.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
13
uses evidence to
establish practice
methods.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
4.4 - Use
knowledge of
research and
evaluation
methods to
critique the
literature that
informs practice.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
4.5 - Seek
information
about the quality
of measures
before using
them to inform
practice.
Other:
☐
☐
Other:
☐
☐
Competency Evaluation for Item 4.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Critically analyze the research literature provided to FI/TS in Indicator 4.3.
Discuss your critical analysis of the articles as applicable to the
agency/institution setting.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 4.4
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Select a specific measure/tool (one either used in the agency or one
which could be used in the agency), research the reliability and validity of
the measure/tool, then have a conversation with the FI/TS about how the
measure/tool was selected and the efficacy of using the measure/tool.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
5 – Excellence
Competency Evaluation for Item 4.5
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 4 –
Engage in Practice-informed Research and Research-Informed Practice:
14
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 4 –
Engage in Practice-informed Research and Research-Informed Practice:
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
15
This student
demonstrates the
ability to:
5.1 - Maintain upto-date
knowledge of
local, state and
federal policies or
proposed
legislation
affecting clients.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
5.2 - Identify and
analyze policies
that impact client
systems,
organizations,
and communities.
Competency 5 – Engage in Policy Practice
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify and read policy manuals, policy briefs as relevant to the
population the agency is serving.
Subscribe to policy blogs from local, state and federal websites
Identify and attend agency and community meetings regarding policy.
Follow agency policies and procedures. Seek consultation when unclear.
Other:
Other:
This student
demonstrates the
ability to:
5.3 - Understand
how contextual
history influences
policy.
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 5.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify agency specific policies and discuss with field instructor and/or
agency leadership.
Research policy and report findings to field instructor, agency leadership
and/or board of directors as appropriate.
Understand Jannson’s framework for policy analysis and utilize it in
reporting.
Discuss with field instructor, the effects of policies, procedures and
legislation on client systems, organizations, and/or communities.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
Check all that
apply
DP
CMPP
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 5.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with FI/TS local, state and/or federal policy history and its impact
on the population.
Discuss history of policy with current and past agency
clients/stakeholders.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
16
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
5.4 - Collaborate
within and across
systems to
advocate for
populations
excluded from or
limited by aspects
of the policy.
Other:
☐
☐
Other:
☐
☐
Competency Evaluation for Item 5.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify ways in which changes in regulations, policies and procedures
would enhance service delivery.
Identify how agency policies and procedures affect diverse populations.
Identify situations that call for advocacy on behalf of client system and
develop and execute strategy for change.
Attend NASW or other organization advocacy day.
Attend coalition meeting related to population served.
Write a letter to an editor or government official or blog with advocacy
content.
Set up meetings with agency, community stakeholders and elected
officials.
Create new collaborative relationships to advocate for change.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
5 – Excellence
Competency Evaluation for Item 5.4
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 5 –
Engage in Policy Practice
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 5 –
Engage in Policy Practice
17
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
18
Competency 6 – Engage with Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
6.1 - Demonstrate
self-awareness
and examine how
personal
experiences,
beliefs and
identities
influence practice
with client
systems, groups,
organizations
and/or
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
6.2 - Understand
and apply how
development and
culture influence
client systems,
groups,
organizations,
and communities
in various
practice contexts.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with field instructor personal/professional identities and their
connection to agency practice.
Review documentation and reports for judgmental and biased language.
With FI/TS and other colleagues, articulate openness to feedback
regarding personal and professional values.
Regularly, ask for feedback from field instructor and colleagues.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 6.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with field instructor human development and cultural influences
and their connection to agency practice.
Articulate knowledge of human development and culture in
documentation and reports.
With field instructor and other colleagues, challenge assumptions and
personal beliefs about human development and culture.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 6.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Check all that
apply
DP
CMPP
19
6.3 - Practice
effective
engagement
through the
development of
cooperative and
respectful
relationships with
others, including
conflict resolution
as needed.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
6.4 - Employ
empathy,
relational, and
strengths based
approaches to
developing
helping
relationships with
diverse client
systems,
organizations,
and/or
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
6.5 - Effectively
prepare and
facilitate
Invite and encourage participation and discussion with client systems,
organizations and/or communities.
Show warmth and respect for others.
Exhibit compassion, helpful intent and acceptance of differences with
client systems, organizations and/or communities.
With client systems, organizations and/or communities, demonstrate a
respect for self-determination with a non-judgmental attitude.
Demonstrate the ability to address client system impasses for change.
In situations where conflict has arisen, show an ability to seek to
understand different perspectives.
Other:
Other:
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 6.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Demonstrate the ability to engage in empathetic listening with client
systems, organizations and/or communities.
Respond to client systems in a way that is positive and productive.
Articulate knowledge of varying perspectives in supervision and meetings
with clients and agency stakeholders.
Show the ability to understand client system strengths in documentation
and reports.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 6.4
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Prepare agendas for meetings.
Take thorough minutes and distribute to members.
Facilitate discussion encouraging all members to participate.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
20
meetings with
Other:
☐
☐
client systems,
organizations,
Other:
and/or
communities
☐
☐
towards
identified goals.
5 – Excellence
Competency Evaluation for Item 6.5
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
Check all that
This student
Select appropriate learning activities and/or add additional activities in
apply
demonstrates the
the “other” box.
ability to:
DP
CMPP
6.6 - Through the
Demonstrate the ability to use active listening.
☐
☐
use of effective
Demonstrate the ability to effectively paraphrase content.
☐
☐
verbal and nonArticulate awareness of non-verbal communication when describing
☐
☐
verbal
client system interactions.
communication,
Other:
☐
☐
consistently
demonstrate the
Other:
critical elements
☐
☐
of a helping
relationship.
5 – Excellence
Competency Evaluation for Item 6.6
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 6 –
Engage with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 6 –
Engage with Individuals, Families, Groups, Organizations, and Communities:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Field Instructor/TS Comments:
21
Student Comments:
22
Competency 7 – Assess Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
7.1 - Have specific
knowledge of
theory to
structure
assessment,
design goals and
objectives and
develop
strategies for
change.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7.2 - Identify the
strengths and
limitations of
theoretical
models
commonly used
in practice
settings.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7.3 - Employ at
least one
instrument or
process used for
assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Practice applying theoretical framework(s) learned in class to the
assessment of agency client systems, organizations and/or communities;
discuss findings with FI/TS
Share class syllabi with FI/TS and discuss applicability of theory to client
systems, organizations and/or communities.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 7.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Practice applying theoretical frameworks learned in class to agency client
system, organization and/or community; identifying strengths,
limitations, and appropriateness for use with field agency; discuss with
FI/TS.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Other:
Competency Evaluation for Item 7.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review assessment tools and approaches used in the agency
Observe other professionals completing assessments. Discuss findings
with agency personnel.
Conduct assessments of client systems, organization and/or community
using the agency’s formal and informal tools, as assigned.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
23
and/or data
collection with
client systems,
organizations
and/or
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7.4 - Write a clear
and
comprehensive
assessment of
client systems,
organizations
and/or
communities
including
mutually agreed
upon goals and
plans for
intervention.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7.5 - Routinely
identify
strengths,
challenges and
systemic factors
relevant to client
systems,
organizations
and/or
communities.
Other:
☐
☐
☐
☐
Other:
Competency Evaluation for Item 7.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Document assessment findings, consistent with agency protocols, for
review by FI/TS.
Document connection/justification of intervention plans to assessment
findings.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 7.4
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review agency assessments of client systems; identify and list strengths,
challenges and relevant systemic factors that are documented in these
assessments.
Include these factors when completing assessment documentation for
the client system, organization and/or community.
Collect information from key persons in client systems, organization
and/or community and include in documentation and/or case review of
assessment.
Present assessment findings in team meetings, agency review
conferences, community stakeholder or board meetings, as appropriate.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
24
Other:
☐
☐
Other:
☐
☐
5 – Excellence
Competency Evaluation for Item 7.5
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
Check all that
This student
Select appropriate learning activities and/or add additional activities in
apply
demonstrates the
the “other” box.
ability to:
DP
CMPP
7.6 - Select
Review evidence based or evidence informed interventions appropriate
evidence based or for client systems and select interventions most suited to agency client
☐
☐
systems.
evidence
informed
Other:
☐
☐
interventions that
integrate
Other:
assessment
information and
connect to the
client systems,
☐
☐
organizations
and/or
community’s
goals.
5 – Excellence
Competency Evaluation for Item 7.6
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 7 –
Assessment:
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 7 –
Assess Individuals, Families, Groups, Organizations, and Communities:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Field Instructor/TS Comments:
25
Student Comments:
Competency 8 – Intervene with Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
8.1 - Critically
analyze and apply
research for
evidence-based
practices and
emerging/promising
practices that are
appropriate for
client systems,
organization,
and/or
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
8.2 - Develop a
cohesive
intervention plan
based on the
needs/goals of
client systems,
organizations, and
or/communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
Select appropriate learning activities and/or add additional activities
in the “other” box.
Research evidence based and/or evidence informed interventions
appropriate for use with client system, agency, or community levels;
discuss findings and applicability with FI/TS.
Apply evidence-based research in implementing interventions with
client systems, organization, or community.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 8.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities
in the “other” box.
Document intervention plan for client systems, incorporating
information on client needs and goals.
Engage client systems, organization, and community in selection of
intervention.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 8.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities
in the “other” box.
Check all that
apply
26
ability to:
8.3 - Collaborate
with
multidisciplinary
teams, agency
and/or community
systems to achieve
desired outcomes
for individuals,
organizations,
and/or
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
8.4 - Working with
leadership, staff
and/or community
groups or coalitions,
negotiate, mediate
and advocate on
behalf of client
systems,
organizations
and/or
communities.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
8.5 - Demonstrate
appropriate timing
and process of
termination,
anticipating client
system,
Include key persons and organizations when developing intervention
plans.
Ensure documentation includes evidence of collaboration with key
persons and organizations in developing interventions for client
systems, agency, or community.
Other:
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 8.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities
in the “other” box.
Advocate for client systems within agency as appropriate.
Engage in advocacy with external systems on behalf of clients,
organization, or community.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 8.4
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities
in the “other” box.
Discuss termination planning with FI/TS and develop a plan for
implementation.
Engage in appropriate implementation of termination process with
client systems, organization, and/or community.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
27
organization,
Other:
and/or
☐
☐
community’s
reaction.
5 – Excellence
Competency Evaluation for Item 8.5
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 8 –
Intervene with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 8 –
Intervene with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
28
Competency 9 – Evaluate Practice with Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
9.1 - Demonstrate
the ability to
identify and
select evaluation
measures for use
in social work
practice,
programs and
policies.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
9.2 - Monitor and
analyze tasks in
the intervention
plan using both
formal and
informal
evaluation
methods,
including
engagement of
client systems
organization
and/or
community and
other
stakeholders in
the evaluation
process.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
Select appropriate learning activities and/or add additional activities in
the “other” box.
Provide FI/TS a copy of the 810 syllabus. Engage in a conversation in how
this assignment can be (or cannot be) carried out in the field setting;
If the 810 evaluation assignment will be completed at the agency, submit
all necessary paperwork within the agency/institution for securing
approval for the research.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 9.1
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
With input from your FI/TS, create a needs assessment, formative
evaluation, process evaluation, or outcome evaluation, engaging at least
one client system (individual, group, or community) or stakeholder in the
development;
Create a client satisfaction survey (client can be at individual, group or
organization level). With the approval of your field instructor and agency
management, administer the survey.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 9.2
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
29
This student
demonstrates the
ability to:
9.3 - Demonstrate
the ability to
analyze data to
inform social
work practice
decisions and
evaluate practice
and program
outcomes.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Share with FI/TS a copy of your SOWO 810 final paper (even if it is
unrelated to practice setting). Explain the data analysis process used. If
the proposal is relevant to the setting, how will these data inform
practice.
Have a conversation with the individual in your agency who is responsible
for evaluation data collection: to learn how data are collected, who does
the statistical analysis, and how findings are reported to administration.
Discuss with FI/TS how data informs changes in practice setting.
Other:
Other:
9.4 - Demonstrate
an understanding
and ability to use
instruments,
tools, record
keeping and
feedback from
others to
evaluate practice.
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 9.3
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
Check all that
apply
DP
CMPP
Select appropriate learning activities and/or add additional activities in
the “other” box.
Meet with the individual at the agency responsible for selecting
instruments and tools used in the practice setting. Discuss why certain
instruments and tools are used and why others are not (e.g. proprietary
costs, time limitations, quality improvement, etc.).
Have conversations with multiple providers at the agency on how they
evaluate their own practice (self-evaluation).
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
5 – Excellence
Competency Evaluation for Item 9.4
4 – Competence
First Evaluation: SOWO 820
Final Evaluation: SOWO 821
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 820 - Student provides a specific, descriptive example of demonstrated competence of Competency 9 –
Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities:
SOWO 820 Comments
(required if there is a
score of 2 or less OR if
Field Instructor/TS Comments:
30
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 821 - Student provides a specific, descriptive example of demonstrated competence of Competency 9 –
Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 821 Comments
(required if there is a
score of 2 or less)
Student Comments:
LEARNING AGREEMENT SIGNATURES
Field Instructor Signature
Task Supervisor Signature
Student Signature
Field Faculty Signature
Date
Date
Date
Date
31
SUMMARY FOR SOWO 820
Overall Rating of Student’s Competency:
Enter rating here
(5 = Excellence, 4 = Competence, 3 = Emerging, 2 = Limited Competence, 1 =
Unsatisfactory)
Student’s Major Strengths and Limitations:
Directions and Goals for Student’s Future Learning:
Field Instructor Signature
Task Supervisor Signature
Student Signature
Field Faculty Signature
Date
Date
Date
Date
SUMMARY FOR SOWO 821
Overall Rating of Student’s Competency:
Enter rating here
(5 = Excellence, 4 = Competence, 3 = Emerging, 2 = Limited Competence, 1 =
Unsatisfactory)
Student’s Major Strengths and Limitations:
Directions and Goals for Student’s Future Learning:
Field Instructor Signature
Task Supervisor Signature
Student Signature
Field Faculty Signature
Date
Date
Date
Date
32