FIELD INSTRUCTOR EVALUATION OF STUDENT RATING SCALE
Internship Placement Program
Michigan Department of Human Services
Ratings are distinct for each semester; they are not cumulative. Under each competency, specific practice
behaviors are listed, along with specific measures for evaluating student performance.
This form may be personalized with comments after each section. If any intern within a section has been
rated Minimally Competent or Not Competent a specific comment must be included regarding that item in
the area provided. In addition, strengths, achievements and initiatives shown by the student in the
performance of his/her assignments and work contact should be noted in the comment sections or
narrative summary.
The Rating Scale is:

Fully Competent: The student demonstrates both knowledge and ability which completely meets
and/or exceeds the criteria set for the practice behavior.

Mostly Competent: The student demonstrates both knowledge and ability which meets a majority
of the basic expectations for the practice behavior.

Moderately Competent: The student demonstrates both knowledge and ability which meets the
basic expectations for the practice behavior.

Minimally Competent: The student requires intensive redirection. The student demonstrates effort
but has difficulty in achieving required expectations for the practice behavior.

Not Competent: The student is unable to perform even minimal tasks and does not demonstrate
an understanding of the theoretical base of materials.

Not Applicable: Student has little or no opportunity to engage in task.
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FIELD INSTRUCTOR EVALUATION OF STUDENT RATING SCALE
Internship Placement Program
Michigan Department of Human Services
Student Name
Student ID Number
College/University
Degree Program
Field Placement Site
Field Instructor Name
Evaluation Period
Year
Mid-Term
Total Hours
Final
5-Fully Competent, 4-Mostly Competent, 3-Moderately Competent, 2-Minimally Competent, 1-Not Competent, N/ANot Applicable
Competency
1
2
3
4
Competency 1 – Identify as a professional social worker and conduct oneself accordingly
Displays appropriate behavior with staff and
clients – professional demeanor
Demonstrates the importance of appearance
and appropriateness in dress
Demonstrates effective communication
Utilizes professional supervision and
consultation
Maintains client confidentiality, professional
roles and boundaries
Demonstrates ability to access services for
clients
Is punctual and adheres to agree upon
attendance schedule
Recognizes the need to manage personal
values and opinions in order to assist clients or
client systems
Comments
Competency 2 – Apply social work ethical principles to guide professional practice
Read and demonstrates an understanding of
the NASW Code of Professional Values and
Ethics
Recognizes the importance of considering
ethical behavior in decision making by applying
the NASW Code to clients and systems
Displays ability to distinguish differences among
self-reflection, self-monitoring, and selfcorrection
Comments
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5
N/A
FIELD INSTRUCTOR EVALUATION OF STUDENT RATING SCALE
Internship Placement Program
Michigan Department of Human Services
Competency
1
2
3
4
5
Competency 3 – Apply critical thinking to inform and communication professional judgments
Demonstrates purposeful oral and written
communication in working with clients and
systems
Displays the ability to organize information in an
appropriate format
Identifies and distinguishes different
assessment tools
Demonstrates awareness of the importance of
using different sources of information
Demonstrates familiarity and how researchbased knowledge affects the client or target
population
Demonstrates effective oral and writing skills
when working with different populations
Comments
Competency 4 – Engage diversity and difference in practice
Communicates the importance of difference in
shaping life experiences
Utilizes diversity sensitive interviewing skills
Recognizes and describes the extent to which a
particular group’s values and structures may
oppress, marginalize, alienate, or enhance the
privilege and power of clients and systems
Demonstrates awareness of the importance of
knowing personal biases and values related to
different groups
Recognizes the importance of fostering a
respect for diversity
Demonstrates awareness of appropriate life
experiences to share with clients, groups and
other individuals
Views and utilizes staff as helpful sources of
information
Comments
Competency 5 – Advance human rights and social and economic justice
Describes the forms and mechanisms of
oppression and discrimination related to the
clients and systems of the agency
Distinguishes the difference between oppresssion and discrimination
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N/A
FIELD INSTRUCTOR EVALUATION OF STUDENT RATING SCALE
Internship Placement Program
Michigan Department of Human Services
Competency
Differentiates case and cause advocacy
regarding human rights and social and
economic justice
1
2
3
4
5
Comments
Competency 6 – Engage in research-informed practice and practice-informed research
Uses research evidence to inform practice
Recognizes why research evidence is used
Acknowledges how research affects the tasks
performed at the agency
Recognizes the need for ongoing and existing
or evidence-based research and evidence
related to the field
Recognizes the importance of practice
experience
Comments
Competency 7 – Apply knowledge of human behavior and the social environment
Demonstrates an understanding of major social
work theoretical frameworks
Articulates the connection between developmental stages and appropriate intervention
Demonstrates familiarity with the processes of
assessment, intervention, and evaluation
Recognizes the importance of understanding
others in their own environment
Demonstrates familiarity with how to gain
information about others in their own
environment
Comments
Competency 8 – Engage in policy practice to advance social and economic well-being and to deliver
effective social work services
Demonstrates an understanding of social
policies
Identifies how particular policies influence
practice
Identifies the role of practice in policy
development
Acknowledges ways to advocate for effective
policy change
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N/A
FIELD INSTRUCTOR EVALUATION OF STUDENT RATING SCALE
Internship Placement Program
Michigan Department of Human Services
Competency
1
2
3
4
5
Comments
Competency 9 – Respond to contexts that shape practice
Identify organization change that impacts clients
and systems
Recognizes the need to make changes to
service delivery to provide effective services
(i.e. different location, different population, etc.)
Recognizes the role of social workers in
providing leadership to support effective
changes
Demonstrates awareness of the profession’s
history and commitment to improving the lives of
those served or their communities
Comments
Competency 10 – Engage with individuals, families, groups, organizations, and communities
Recognize and distinguish between verbal and
non-verbal communication as expressed by
clients, colleagues, etc.
Recognizes the role he/she plays with
clients/groups/organizations/communities
Acknowledges that all participants enter the
agency at different stages with different needs
Recognizes and employs the appropriate uses
of empathy
Acknowledges why work goals and desired
outcomes are created and used during field
work
Recognizes and understands methods for
collecting, organizing, and interpreting client
data from a variety of sources
Recognizes and employs the different types of
intervention strategies
Identifies the special engagement needs of
diverse clients across systems and the life span
Assesses strengths and challenges of clients
and systems in working toward case
conceptualization
Develop mutually agreed-upon client and
system goals
Identifies major social work interventions to help
clients and systems solve problems
Initiates culturally sensitive and developmentally
appropriate actions to achieve client/system
goals
Considers prevention strategies as an integral
part of the intervention process
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N/A
FIELD INSTRUCTOR EVALUATION OF STUDENT RATING SCALE
Internship Placement Program
Michigan Department of Human Services
Competency
1
2
3
4
5
N/A
Assesses personal and professional strengths
and challenges
Remains open to self-reflection and feedback
Comments
Additional Competencies
Comments
Would the DHS Field Instructor recommend the intern for a position with the Department of Human Services?
Yes
No (If no, why not?)
Additional Feedback
I have reviewed the above evaluation and acknowledge receipt:
Student Signature
Date
Field Instructor Signature
Date
Field Liaison Signature
Date
Recommended Grade (based on college/university grading scale, i.e. 4.0 scale, Pass/Fail or letter grade)
Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight,
marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the
Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.
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