PERFORMANCE EVALUATION
SUMMER FULL TIME ADVANCED STANDING
SoWo 522
Student
Email
Field Instructor
Email
Task Supervisor
Email
Agency
Dept./Division
City
State
Field Faculty
Email
Office Phone
_______
Zip Code
Fax
Other
In general, the UNC-CH, School of Social Work recommends that the student’s performance evaluation be completed in discussion
between the field instructor and the student in consultation with the field faculty member. However, the School realizes and
respects that based on agency culture and personal preference, the form may be completed by the field instructor alone. The form
must be entered on-line where the field instructor, task supervisor (if applicable), student and field faculty member should sign the
evaluation electronically. The evaluation becomes part of the student’s permanent record. Both student and field instructor should
keep a printed copy of this document.
Field Evaluation Grading Criteria
Responsibility for assigning the grade belongs to the field faculty member.
A grade of either P (pass), L (low pass), or F (fail), or IN (incomplete) is assigned by field faculty, at the end of each semester/summer
session in which the student has registered for field education. P indicates satisfactory performance and F unsatisfactory
performance. 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
performance. 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 for 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 following semester.
For each item in the following sections, the field instructor should rate the student’s performance relative to where they are in the
program (e.g. foundation vs. concentration, first semester vs. second semester). The rating scale for this form ranges from 1 to 5,
with 1 indicating the need for significant improvement and 5 indicating exceptional mastery. NA (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 outcomes during
the first semester when beginning to practice new skills but a rating of a 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.
Provide an overall rating for the student’s performance, as indicated at the end of each category and a brief narrative in the
comments section.
UNC-CH School of Social Work, Field Education Office
325 Tate, Turner, Kuralt Bldg., CB # 3550
Chapel Hill, NC 27599-3550
Phone: 919.966.4916 FAX: 919/962.3384
http://www.uncssw.org
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PERFORMANCE EVALUATION
SUMMER FULL TIME ADVANCED STANDING
Goal #1
Bridging the BSW and MSW: Self-assessment
Performance Rating Scale
1…Unacceptable (never or rarely meets criteria)
2…Needs improvement (meets criteria inconsistently)
3…Satisfactory (meets criteria most of the time)
4…Very Good (consistently meets criteria)
5…Outstanding (consistently exceeds criteria)
NA… Not applicable at this time or in this setting
Outcomes
Ratings (circle one)
At the completion of the summer advanced standing field placement the student is able to:
a. Identify specific skills and knowledge base needing development,
1
2
3
4
5
NA
b. Develop an understanding of social work practice skills utilized in
the Agency; and,
c. Secure caseload/work product expectations and activities.
1
2
3
4
5
NA
1
2
3
4
5
NA
Comments:
Goal #2
Understanding the Agency’s Operation.
Outcomes
Ratings (circle one)
At the completion of the summer advanced standing field placement the student is able to:
a. Develop professional/working relationships with program staff
and supervisor; and,
b. Familiarize self with Agency program and policy.
1
2
3
4
5
NA
1
2
3
4
5
NA
Comments:
2
PERFORMANCE EVALUATION
SUMMER FULL TIME ADVANCED STANDING
Goal #3
Understanding the Agency Role in the Community System
Performance Rating Scale
1…Unacceptable (never or rarely meets criteria)
2…Needs improvement (meets criteria inconsistently)
3…Satisfactory (meets criteria most of the time)
4…Very Good (consistently meets criteria)
5…Outstanding (consistently exceeds criteria)
NA… Not applicable at this time or in this setting
Outcomes
Ratings (circle one)
At the completion of the summer advanced standing field placement the student is able to:
a. Learn about programs that complement services provided by the
Agency;
b. Familiarize self with demographics represented in the Agency as
well as in the greater population; and,
c. Learn about available local, state and national resources that
provide services and advocacy for individuals represented by the
agency.
1
2
3
4
5
NA
1
2
3
4
5
NA
1
2
3
4
5
NA
Comments:
Goal #4
Understanding the Agency’s Operation.
Outcomes
Ratings (circle one)
At the completion of the summer advanced standing field placement the student is able to:
a. Develop appropriate Concentration Learning Agreement, and
1
2
3
4
5
NA
b. Pursue learning opportunities within the agency as deemed
appropriate.
1
2
3
4
5
NA
Comments:
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PERFORMANCE EVALUATION
SUMMER FULL TIME ADVANCED STANDING
Overall Student Rating
1 2 3 4 5 NA
Student’s Major Strengths and Limitations:
Directions and Goals for Student’s Future Learning:
Field Instructor’s Signature:
Date:
Task Supervisor’s Signature:
Date:
Student’s Signature:
Date:
Field Faculty Signature:
Date:
Please enter online by the last day of field instruction for each semester.
Performance Rating Scale
1…Unacceptable (never or rarely meets criteria)
2…Needs improvement (meets criteria inconsistently)
3…Satisfactory (meets criteria most of the time)
4…Very Good (consistently meets criteria)
5…Outstanding (consistently exceeds criteria)
NA…Not applicable at this time or in this setting
UNC-CH School of Social Work
Field Education Office
325 Tate, Turner, Kuralt Bldg., CB # 3550
Chapel Hill, NC 27599-3550
Phone: 919.966.4916 FAX: 919/962.3384
http://www.uncssw.org
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