WEEKLY SUPERVISION/PERFORMANCE FEEDBACK
SOCIAL WORK FIELD PLACEMENT
Instructions:
1) This should take only 10-15 minutes to complete. You only need to write a few key words that
will tune us into areas to explore.
2) Please give this to your field instructor before your meeting as this will help launch a
conversation and exploration of your placement.
3) Depending on your placement, you may need to attach a list of all clients seen since your last
meeting. If required, bring your case notes to review with your field instructor.
4) The reflections you share will be used by your field instructor and will assist him/her in
completing your mid-placement and final evaluations.
5) We realize that you will not be able to address every issue on this form every time you meet, but
this tool will help you and your field instructor focus on specific areas and can serve as
documentation that you are thinking about practice issues and their relationship to your other
course work.
1) What went well this week?
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2) How did you demonstrate awareness of and commitment to the NASW Code of Ethics and the
Minnesota Board of Social Work Standards of Practice and Ethical Behavior?
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3) Identify a situation in which you encountered some facet of diversity this past week:
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4) Which current or previous graduate course was of value this week in field, and why?
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5) Learning Contract: What objectives have you begun, worked on, or accomplished since our last
supervisory session?
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6) Learning Contract: What objectives are you going to focus on for our next supervisory session?
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7) By the end of your placement, we expect that you will have experience, knowledge, and skills in all of
the following areas that are included on your Learning Contract. To help you and your field instructor
connect what you are learning each week to your learning objectives, please check one area on which you
focused this week and answer question #8 below :
__Agency & Community-Specific Competency Area
__Foundation Social Work Methods Competency Area (all foundation & concentration year students)
__Diversity & Social Justice Competency Area
__Professional Social Work Identity/Responsibilities Competency Area
__Professional Work Skills Competency Area
__Community Practice Methods Competency Area (community practice students only)
__Child Welfare IV-E Methods and Skills Competency Area (IV-E students only)
8) Which area from question #7 became a focus this week? What did you learn about yourself?
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9) Are you getting what you need from this field placement? How can your placement be improved? (If
you have concerns and are worried about bringing them up with your field instructor, please talk with
your liaison, who can help you complete this question).
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10) Additional comments or agenda items (case reviews, etc.) that you want to make sure we discuss this
week:
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11) Field Instructor comments (feedback, affirmations, guidance):
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Social Work Graduate Intern
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Date
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Field Instructor
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Date
Form initially created by Edwin Rivera, United Health Services, Binghamton, NY and adapted by University of Minnesota Field Team (2009).