Senior Field Evaluation Form
The following form is to be used to evaluate the student’s basic work skills in a practice setting.
Student Name:
Agency:
Supervisor completing this form:
Date:
Please forward this evaluation to:
Michelle George MSW, LCSW, BCD
mgeorge@messiah.edu
Field Coordinator
Messiah College
One College Avenue, Box 3057
Grantham, PA 17027
Performance Level
Area
Student arrives on
time/ leaves when
scheduled
Student uses time
effectively during
placement
Student informs
field instructor of
actions
Student notifies
agency if absent or
needs time off
Student is reliable
and completes
1
Poor-does
not meet
standard
2
Fair
3
Good-meets
standard
4
Very Good
5
Excellentconsistently
exceeds
expectations
tasks on time
Student is
responsive to
agency norms
Student interacts
appropriately with
other staff
Student completes
assigned hours/
days on site
Evaluation Form: Part 2
The student and the field supervisor must complete this section of the evaluation together by the
date previously specified. Please complete the following assessment of student competencies and
include as much detail as possible. The evaluation is based upon the ten CSWE Core
Competencies of the Social Work program that were provided to you prior to the student’s
placement.
1. Identify as a professional social worker and conduct oneself accordingly
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Advocate for client access to services of social work
Poor
Fair
Good
Very Good
Excellent
B. Practice personal reflection and self-correction to assure continual professional development
Poor
Fair
Good
Very Good
Excellent
C. Attend to professional roles and boundaries
Poor
Fair
Good
Very Good
Excellent
D. Demonstrate professional demeanor in behavior, appearance, and communication
Poor
Fair
Good
Very Good
Excellent
E. Engage in career-long learning
Poor
Fair
Good
Very Good
Excellent
F. Use Supervision and consultation
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
2. Apply social work ethical principles to guide professional practice
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Recognize and manage personal values in a way that allows professional values to guide
practice
Poor
Fair
Good
Very Good
Excellent
B. Make ethical decisions by applying standards of the NASW Code of Ethics and as applicable,
of the International Federation of Social Workers/ International Association of Schools of Social
Work Ethics in Social Work, Statement of Principles
Poor
Fair
Good
Very Good
Excellent
C. Tolerate ambiguity in resolving ethical conflicts
Poor
Fair
Good
Very Good
Excellent
D. Apply strategies of ethical reasoning to arrive at principled decisions
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
3. Apply critical thinking to inform and communicate professional judgments
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Distinguish, appraise, and integrate multiple sources of knowledge, including research-based
knowledge, and practice wisdom
Poor
Fair
Good
Very Good
Excellent
B. Analyze models of assessment, prevention, intervention, and evaluation
Poor
Fair
Good
Very Good
Excellent
C. Demonstrate effective oral and written communication in working with individuals, families,
groups, organizations, communities, and colleagues
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
4. Engage diversity and difference in practice
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Recognize the extent to which a culture’s structures and values may oppress, marginalize,
alienate, or create or enhance privilege and power
Poor
Fair
Good
Very Good
Excellent
B. Gain sufficient self-awareness to eliminate the influence of personal biases and values in
working with diverse groups
Poor
Fair
Good
Very Good
Excellent
C. Recognize and communicate their understanding of the importance of difference in shaping
life experiences
Poor
Fair
Good
Very Good
Excellent
D. View themselves as learners and engage those with whom they work as informants
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
5. Advance human rights and social and economic justice
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Understand the forms and mechanisms of oppression and discrimination
Poor
Fair
Good
Very Good
Excellent
B. Advocate for human rights and social and economic Justice
Poor
Fair
Good
Very Good
Excellent
C. Engage in practices that advance social and economic justice
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
6. Engage in research-informed practice and practice-informed research
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Use practice experience to inform scientific inquiry
Poor
Fair
Good
Very Good
Excellent
B. Use research to inform practice
Poor
Fair
Very Good
Excellent
Good
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
7. Apply knowledge of human behavior and the social environment
Practice Behaviors Performance Indicators: Please indicate to what degree the student exhibits
the following behaviors
A. Utilize conceptual frameworks to guide the process of assessment, intervention, and
evaluation
Poor
Fair
Good
Very Good
Excellent
B. Critique and apply knowledge to understand person and environment
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
8. Engage in policy practice to advance social and economic well-being and to deliver
effective social work services
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Analyze, formulate, and advocate for policies that advance social well-being
Poor
Fair
Good
Very Good
Excellent
B. Collaborate with colleagues and clients for effective policy action
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
9. Respond to contexts that shape practice
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Continuously discover, appraise, and attend to changing locales, populations, scientific and
technological developments, and emerging societal trends to provide relevant services
Poor
Fair
Good
Very Good
Excellent
B. Provide leadership in promoting sustainable changes in service delivery and practice to
improve the quality of social services
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
10. Engage, assess, intervene, and evaluate with individuals, families, groups,
organizations, and communities
Practice Behaviors Performance Indicators: Please indicate to what degree the student
exhibits the following behaviors
A. Engagement
Substantively and effectively prepare for action with individuals, families, groups, organizations
and communities
Poor
Fair
Good
Very Good
Excellent
Use empathy and other interpersonal skills
Poor
Fair
Good
Very Good
Excellent
Develop a mutually agreed-on focus of work and desired outcomes
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
B. Assessment:
Collect, organize, and interpret client data
Poor
Fair
Good
Very Good
Excellent
Good
Very Good
Excellent
Develop mutually agreed-on intervention goals and objectives
Poor
Fair
Good
Very Good
Excellent
Select appropriate intervention strategies
Poor
Fair
Excellent
Assess client strengths and limitations
Poor
Fair
Good
Very Good
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
C. Intervention
Initiate actions to achieve organizational goals
Poor
Fair
Good
Very Good
Excellent
Implement prevention interventions that enhance client capacities
Poor
Fair
Good
Very Good
Excellent
Help clients resolve problems
Poor
Fair
Good
Very Good
Excellent
Negotiate, mediate, and advocate for clients
Poor
Fair
Good
Very Good
Excellent
Facilitate transitions and endings
Poor
Fair
Very Good
Excellent
Good
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
D. Evaluation
Social workers critically analyze, monitor and evaluate interventions
Poor
Fair
Good
Very Good
Excellent
Comments:
11. Apply Christian faith development principles to inform and guide professional practice
Practice Behaviors Performance Indicators: Please indicate to what degree you exhibit the
following behaviors
Critically evaluated issues of integration of Christian faith and social work practice.
Poor
Fair
Good
Very Good
Excellent
Effectively utilized appropriate integration of Christian faith into social work practice.
Poor
Fair
Good
Very Good
Excellent
Narrative: Please provide an example from the student’s performance to support the level
of competency that you evaluated.
Comments:
By Signing below I am indicating that the field instructor and the student have collaborated in
developing this evaluation and that any problem areas have been discussed.
Field Instructor Name:
Signature __________________________________________ Date:
Student Name:
Signature __________________________________________ Date:
Field Coordinator/Field Liaison Name:
Signature __________________________________________ Date: