Student Evaluation of Placement
Division of Social Work, University of Wyoming
Student name_____________________________________ Date_________________
Name of Agency_______________________________________________________
Name of Field Instructor________________________ FI Degree_________________
Semester(s) and year of placement______________________________
Program:
___BSW
___MSW Foundation
___MSW Advanced
Name of Onsite Supervisor (If applicable):__________________Onsite Supervisor Degree______
Did the agency provide adequate space, supplies and equipment for you to fulfill your
student responsibilities?
___Yes ___No
If no, explain_____________________________________________________
_______________________________________________________________________
Did you have a regularly scheduled, weekly time to meet with your field instructor?
___Yes ___No
If, no what were the circumstances__________________________________________
_______________________________________________________________________________
Please rate your experience by responding to the following statements using the following
scale:
1 Not at all ; 2 Sometimes; 3 Regularly; 4 Often; 5 Frequently
Overall this field placement, as a whole:
Provides a variety of appropriate learning opportunities 1
2
3
4
5
Provides opportunities to meet learning goals
1
2
3
4
5
Challenged me in ways I had not anticipated
1
2
3
4
5
Incorporates current trends in social work
1
2
3
4
5
Suggests or provides reading related to population served 1
2
3
4
5
Provides an adequate number of client interactions
1
2
3
4
5
Provides services to a diverse population
1
2
3
4
5
Is an advocate for social and economic justice
1
2
3
4
5
Comments:_____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
The Field Instructor
Matches teaching style to student learning style
Creates and maintains a positive working relationship
Assists in developing the learning contract
Integrates field and classroom learning
Engages student in self examination
Models healthy boundaries (with student)
(in practice)
Uses constructive criticism to encourage growth
Revised8/11/2010
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
Contact or return to:
Field Coordinator: Liz Dole-Izzo, LCSW
307-766-2710 or fax 307-766 6
edoleizz@uwyo.edu
5
5
5
5
5
5
5
5
Involves student in self evaluation
Is familiar with the schools expectations
1
1
2
2
3
3
4
4
5
5
Comments:_______________________________________________________________
_______________________________________________________________________________
_____________________________________________________________________________
The Onsite Supervisor (if applicable):
Is familiar with the schools expectations
Participates in creating the learning contract
Participates in evaluations
Addresses strengths and weaknesses constructively
Communicates effectively with FInstructor and FLiaison
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
5
5
Comments:_____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________
The Agency
Provides thorough orientation to mission
Provides thorough orientation to processes
Provides the opportunity for supervised activity
Provides the opportunity for independent work
Offers intervention at all levels (individual & family)
(team work & groups)
(community)
(policy)
Offers opportunities to act as supervisor to others
Offers continuing education opportunities
Includes students as colleagues
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
Comments:_____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________
Recommendations for future use of this field site
___Continue use of this placement
___Continue use of this Field Instructor
___ Continue use of this Onsite Supervisor
___Continue use of this placement with the following modification (Provide written response below)
___Discontinue use of this placement for the following reasons (Provide written response below)
_______________________________________________________________________________
_______________________________________________________________________________
_____________________________________________
Revised8/11/2010
Contact or return to:
Field Coordinator: Liz Dole-Izzo, LCSW
307-766-2710 or fax 307-766 6
edoleizz@uwyo.edu