BSW Mid-semester Evaluation
School of Social Work
APPENDIX I
University of North Carolina @ Wilmington
This evaluation will assess the student’s mid-semester progress in field placement. Both student and field instructor are asked to
complete the evaluation copy independently and then work together to achieve consensus on the completed form. Please return the
completed evaluation forms to your faculty liaison.
Student: ________________________ Field Instructor: ______________________________
Field Agency: _________________________ Phone: ________________________________
Rating Scale:
5 = superior performance
4 = exceeds expected outcomes
3 = meets expected outcomes
2 = performance needs strengthening
1 = does not meet expected outcomes
NA = not applicable
Section 1: The student demonstrates:
Circle Appropriate rating
A.
1.
2.
3.
4.
5
5
5
5
4
4
4
4
3
3
3
3
2
2
2
2
1
1
1
1
NA
NA
NA
NA
5
5
5
5
5
5
5
5
4
4
4
4
4
4
4
4
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
1
1
1
1
1
1
1
1
NA
NA
NA
NA
NA
NA
NA
NA
5
5
5
5
5
4
4
4
4
4
3
3
3
3
3
2
2
2
2
2
1
1
1
1
1
NA
NA
NA
NA
NA
TIME MANAGEMENT
punctuality
regularity in attendance
an ability to organize his/her work
an ability to complete assigned work
Comments:
B.
1.
2.
3.
4.
5.
6.
7.
8.
PROFESSIONAL BEHAVIOR
appropriate professional dress suited to the client population
commitment to social work values
an ability to adhere to the NASW Code of Ethics
an ability to take initiative
dependability
professional behavior (courtesy, respectfulness, etc.)
an ability to be flexible
an ability to tolerate ambiguity
Comments:
C.
1.
2.
3.
4.
5.
USE OF SUPERVISION
a willingness to discuss issues, concerns, and questions
an ability to explore feelings/issues arising from the internship
an ability to initiate discussion
a commitment to preparing a weekly agenda
an ability to receive and utilize constructive criticism
Comments:
Mid- semester Evaluation, page 2
D.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
BEGINNING PRACTICE
an ability to articulate beginning knowledge of the agency
an ability to articulate the social work roles in the agency
an ability to acquire information about the community
effective interaction with staff/co-workers
an ability to identify client concerns and strengths
beginning assessment skills in working with clients
an ability to accept client’s right to self-determination
beginning goal-setting/care planning skills
an ability to be sensitive to diversity
beginning documentation skills
Circle Appropriate Rating
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
5 4 3 2 1 NA
Comments:
Briefly summarize the student’s activities to date. Be sure to include student strengths in carrying
out assigned activities.
SECTION 11: To be completed by the student
Completed Field Hours _________
Briefly describe the highlights of the placement. Be sure to comment on the evaluation process.
Student Signature ____________________________________________Date____________________
Field Instructor’s Signature ____________________________________Date____________________
Field Liaison Signature ________________________________________Date____________________
Revised 10/10/12