UMSL School of Social Work, MSW Program
Social Work Leadership and Management Concentration
Agency Supervisor's Final Evaluation (revised 05/2014)
Course 6800
Course 6850
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.
*Practice behaviors in italics are specific to advanced practice with social work leadership and management
and are part of the Learning Agreement
 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
1
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Establishes and
maintains effective
professional relations
with clients, co-workers,
representatives from
other disciplines and
other agencies
Organizes time and
plans work accordingly
Demonstrates initiative
and resourcefulness in
practicum
Understands agency's
mission, goals, function
and role
Effectively uses
personal reflection,
self-correction,
supervision and
consultation to
enhance professional
practice
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
Tolerates ambiguity in
resolving ethical conflicts
Applies ethical standards
and laws, and assesses
potential tension/conflicts in
their application, in
professional social work
practice in organizations
and communities
2
Applies ethical reasoning in
promoting human rights and
social justice in
assessment, intervention,
and evaluation of
organizational and
community practice
Comments:

. 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
Synthesizes theoretical and
practice frameworks and
sources of information to
make professional
judgments
Uses logic, critical thinking
and creativity in written and
oral communication with
organizations and
communities
Comments:
3
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
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
Builds on strengths and
ensures participation of
diverse and marginalized
organizations and
community constituents in
assessing, planning,
implementing and
evaluating interventions
Comments:
4
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
Advances human rights and
social justice principles
aimed at eliminating social,
economic and
environmental injustice in
organizations, communities,
institutions and society
Comments:
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
5
Uses best practice
evidence-informed research
to develop, implement and
evaluate organizational and
community interventions
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
Engages in interventions
that enhance the ability of
organizations and
communities to improve
well being
Comments:
6
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
Analyze polices from
historical, current and
global perspectives
understanding the role of
social, economic and
political forces on policy
formulation, and
implications for less
powerful and oppressed
groups
Engages in policy practice,
including collaboration and
advocacy for policies that
improve effectiveness of
social services and well
being, especially among the
most vulnerable
Comments:
7
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.)
Recognizes that the context of
practice is dynamic and has
the knowledge and skills to
respond proactively
Provides leadership in
organizations and
communities for effective,
ethical interventions that
improve the well being of
individuals, families,
organizations and
communities
Applies theoretical
framework to assess and
analyze the impact of social,
economic and political
contexts on organizations,
especially NPOs.
Strategically plan
organizational and
community change and
development to improve
social, economic, political
and environmental well
being
Comments:
8
X. Engages, assesses, intervenes, and evaluates with individuals, families, groups,
organizations and communities (EPAS 2.1.10)
Unacceptable Deficient
Developing Accomplished
1
2
3
4
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Engagement
Substantively and affectively
prepares for action with
individuals, families or groups
Embodies the concept of
starting where the client is
Conveys respect for the client
Uses empathy and other
interpersonal skills
Develops a culturally
responsive therapeutic
relationship with a client
Encourages clients to be
equal partners in the
establishment of treatment
goals and/or expected
outcomes
Assessment
Collects, organizes, and
interprets client data
Assesses client strengths and
limitations
Engage with organizations,
communities, and their
constituencies to assess
and analyze
community/organization
capacities, strengths and
needs
Intervention
Utilizes agency services and
community resources on
behalf of client
9
Inconsistently
meets
competency
Consistently
meets
competency
Exemplary
5
Consistently
exhibits
mastery of
competency
Helps clients resolve problems
Facilitates transitions and
endings
Disseminate evidence-based
outcomes of interventions
that contribute to
understanding effects on
well being
Evaluation
Engages stakeholders,
including staff and
community members, in
participatory planning,
intervention and evaluation
Demonstrates leadership
and skill in human service
organizations, in areas such
as policy and task analysis,
advocacy, governance,
planning, program
development and program
management, financial
development/management,
evaluation, human
resources, and staff
development
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?
Is your organization planning any changes (such as in staffing, programming, etc.) of which the University
should be aware? Please describe:
10
Please check the box 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
advanced-practice level MSW student?
1. Outstanding
2. Above average
3. Average
4. Below average
5. Poor
If this is the student’s final semester in field placement, please provide your assessment of this
student’s readiness for entry level social work practice.
1. Surpasses expectations for entry level social work practice
2. Meets expectations for entry level social work practice
3. Meets expectations for entry level social work practice with the following exceptions:
4. Does not meet expectations for entry level social work practice. Please explain:
5. Does not apply. This student is not in his/her final semester of field placement
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 or by mail to: UMSL School of Social Work, Field Education
Office, One University Blvd., St. Louis, MO 63121. Electronic signatures in any format are considered legal and binding by Missouri law and are
therefore acceptable for this practicum document, provided it is sent from the email address of the practicum supervisor.
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