School of Social Work, UM-St. Louis, MSW Program
Foundation Field Experience
Course 5800
Agency Supervisor's Final Evaluation (Revised 05/2014)
Return forms: Hand-signed forms may be submitted in person or by fax to: (314) 516-6416. Forms sent as an email attachment to
socialwork@umsl.edu may be signed electronically provided the document is sent from the professional email address of the practicum
supervisor, and the student signer is copied. This fill form works best when using a PC and Internet Explorer.
Student's Name:
Student ID#:
Semester:
Year:
Agency Name:
Supervisor's Name:
Phone:
Please complete the evaluation below by placing a check mark in the rating box that is appropriate for the student for
each practice behavior identified. Please use the comment area to discuss ways in which the competency was met
and to identify any areas in which you believe the student is particularly strong or those areas that need improvement.
 Professional Identification: Identifies as a professional social worker and conducts oneself
accordingly (EPAS 2.1.1)
Unacceptable Deficient
Developing Accomplished Exemplary
1
2
3
4
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Advocates for client access
to the services of social
work
Attends to professional
roles and boundaries
Understands and follows
agency policies and
procedures
Demonstrates professional
demeanor in behavior,
appearance, and
communication
Uses supervision and
consultation
Establishes and maintains
effective professional relations
with clients, co-workers,
representatives from other
disciplines and other agencies
Organizes time and plans
work accordingly
1
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates initiative and
resourcefulness in practicum
Understands agency's
mission, goals, function and
role
Comments:

. Applies social work ethical principles to guide professional practice (EPAS 2.1.2)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates knowledge of,
and abides by, the NASW
Code of Ethics in practice
Recognizes and manages
personal values in a way that
allows professional values to
guide practice
Tolerates ambiguity in
resolving ethical conflicts
Applies strategies of ethical
reasoning to arrive at
principled decisions
Comments:
2

. Applies critical thinking to inform and communicate professional judgments (EPAS 2.1.3)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates effective oral
and written communication in
working with individuals,
families, groups,
organizations, communities,
and colleagues
Distinguishes, appraises, and
integrates multiple sources of
knowledge, including
research-based knowledge
and practice wisdom
Identifies problems and seeks
solutions by identifying options
while respecting different
values
Comments:
IV. Engages diversity and difference in practice (EPAS 2.1.4)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates awareness and
sensitivity to racial, ethnic,
cultural, religious, gender,
disability, and sexual
orientation factors in
understanding clients
3
Has sufficient self-awareness
to eliminate the influence of
personal biases and values in
working with diverse groups
Recognizes and
communicates
understanding of the
importance of difference in
shaping life experiences
Views self as a learner, and
engages those with whom
he/she works as informants
Comments:
V. Advances human rights and social and economic justice (EPAS 2.1.5)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Engages in practice that
advances social and
economic justice
Recognizes that each person,
regardless of position in
society, has basic human
rights, such as freedom,
safety, privacy, an adequate
standard of living, health care
and education
Comments:
4
VI. Engages in research-informed practice and practice-informed research (EPAS 2.1.6)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Identifies the research base
for the work done at the
agency
Uses research evidence to
inform practice
Comments:
VII. Applies knowledge of human behavior and the social environment (EPAS 2.1.7)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Utilizes conceptual
frameworks to guide the
processes of assessment,
intervention, and evaluation
Demonstrates an
understanding of how
biological, psychological, and
cultural factors influence
human behavior
Demonstrates an
understanding about the ways
in which social systems
promote or deter people in
maintaining or achieving
health and well-being
5
Comments:
VIII. Engages in policy practice to advance social and economic well-being and to deliver
effective social work services (EPAS 2.1.8)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Identifies the role of policy in
service delivery
Collaborates with
colleagues and clients for
effective policy action
Comments:
IX. Responds to the contexts that shape practice (EPAS 2.1.9)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Identifies and analyzes factors
that impact the agency's
mission and service delivery
system (i.e., organizational
structure, operation, policies,
funding, scientific
developments, economy, etc.)
6
Provides leadership in
promoting sustainable
changes in service delivery
and practice to improve the
quality of social services
Recognizes that the context of
practice is dynamic and has
the knowledge and skills to
respond proactively
Comments:
X. Engages, assesses, intervenes, and evaluates with individuals, families, groups,
organizations and communities (EPAS 2.1.10)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Engagement
Substantively and
affectively prepares for
action with individuals,
families, groups,
organizations, and
communities
Embodies the concept of
starting where the client is
Conveys respect for the client
Uses empathy and other
interpersonal skills
Assessment
Collects, organizes, and
interprets client data
Assesses client strengths
and limitations
7
Develops mutually agreedon intervention goals and
objectives
Selects appropriate
intervention strategies
Intervention
Understands how practicum
tasks and responsibilities
achieve organizational goals
Utilizes agency services and
community resources on
behalf of client
Initiates actions to achieve
organizational goals
Helps clients resolve
problems
Negotiates, mediates, and
advocates for clients
Facilitates transitions and
endings
Evaluation
Critically analyzes, monitors,
and evaluates interventions
Comments:
Please describe the student’s primary strengths and areas for growth.
Strengths:
Growth Areas:
In what ways could the social work faculty have been more helpful to the agency or the student
during the course of the practicum?
8
Is your organization planning any changes (such as in staffing, programming, etc.) of which the
University should be aware? Please describe.
Please place a check mark next to the number that reflects your response to the following
questions.
How would you rank this student’s effort in completing practicum tasks?
1. Consistent and outstanding
2. Consistent and above average
3. Consistent and average
4. Inconsistent and average
5. Inconsistent and below average
How would you rank this student’s level of knowledge and skill compared to a typical foundation
level MSW student?
1. Outstanding
2. Above average
3. Average
4. Below average
5. Poor
Please check to verify that the student has completed 300 practicum hours:
Supervisor Signature
Date
Student Signature
Date
Return forms by email attachment to: socialwork@umsl.edu, by fax to: (314) 516-6416. Forms submitted as an email attachment
may use an electronic signature provided the document is sent from the professional email address of the practicum supervisor,
and the student signer is copied. .
9