_________________________________________________________________________
College of Health and Human Services
Department of Social Work
Field Education
749 Chestnut Street
Terre Haute, Indiana 47809
Telephone: 812-237-2322
Fax: 812-237-8114
Student Evaluation of Field Practicum
Course: _____________
Date: ____________
Semester:
□ Fall □ Spring
Student Name:
__________________________________________________
Field Agency:
__________________________________________________
Field Instructor:
__________________________________________________
Task Supervisor, if applicable: ___________________________________________
Directions: Place a check mark (√) in the box that you think best answers the question. Please
give supporting documentation for your responses.
Knowledge, Value, and Skill Development
Questions
Frequently
Sometimes
Rarely
Never
Did the placement offer opportunity to apply skills of the generalist framework?
engagement
assessment
planning
implementation
evaluation
termination
Did the placement offer opportunity to work with different size client systems?
individual
families
groups
local community
organizations
Did the placement provide opportunity to develop macro level skills in
identifying policies of concern?
applying policy-related interventions?
Did the placement provide opportunity to work with
supervisors and colleagues?
community agencies?
Did the placement provide opportunity to
practice oral communication skills?
get feedback on oral communication?
N/A
Knowledge, Value, and Skill Development
Questions
Frequently
Were professional work habits
emphasized? (such as attendance,
follow through, punctuality,
organization, etc.)
Sometimes
Rarely
Never
N/A
Did the placement offer opportunity to
practice a range of interventions?
Was support given in acquiring and
developing self assessment skills?
MSW Clinical Only (2 items below)
Were clinical opportunities
emphasized in this placement?
Did the placement setting offer ample
opportunity for development of your
clinical concentration skills?
Comments:
___________________________________________________________________________
___________________________________________________________________________
Agency Environment
Questions
Yes
Somewhat
No
Was orientation provided for
the agency?
the program of assignment?
the organizational structure?
agency policy and procedures?
safety and infection control?
Did you feel part of
the agency?
the staff?
Did you make efforts to become part of
the agency?
the staff?
Explain:
Did the field experience challenge you to develop your social work
knowledge?
skills?
MSW Clinical Only (2 items below)
Did the field experience challenge you to develop
clinical skills?
Did this agency serve clients relevant to your clinical
concentration?
Comments:
___________________________________________________________________________
___________________________________________________________________________
Field Supervision
Questions
Individual
Group
Both
What type of supervision did you receive?
<1 hr/wk
1 hr/wk
>1 hr/wk
BSW
MSW
Satisfactory
Unsatisfactory
With what frequency was your supervision?
What degree does your Field Instructor hold?
Field Instructor
Facilitated orientation to agency
Invited participation in meetings
Encouraged visits to community resources
Facilitated understanding & use of policies
Encouraged self-assessment & evaluation
Provided fair and useful feedback
Facilitated learning of practice skills
Was accessible
Modeled professional values and ethics
Excellent
Very Good
Task Supervisor (if applicable)
Excellent
Very Good
Satisfactory
Unsatisfactory
Facilitated orientation to agency
Invited participation in meetings
Encouraged visits to community resources
Facilitated understanding & use of policies
Encouraged self-assessment & evaluation
Provided fair and useful feedback
Facilitated learning of practice skills
Was accessible
Modeled professional values and ethics
Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
General/Overall Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Updated: Spring 2002, 7/05, 7/07, 8/08, 8/09, 8/12, 8/13, 8/15