6-­‐Week Assignment 1 Adelphi University School of Social Work Field Education Department Six Week Assignment & Educational Plan Name of Student: Click here to enter text. Click here to enter a date. Name of Liaison: Click here to enter text. Name of Agency & Field Instructor: Click here to enter text. Field Instructor E-­‐mail Address: Click here to enter text. Hours in Field Per Week: Click here to enter text. Days in Field: ☐ Mon. ☐ Tues. ☐ Wed. ☐Thurs. ☐ Fri. ☐Sat. ☐ Sun. Number of Process Recordings Completed & Reviewed Per Week: Click here to enter text. Day & Time of Regular Weekly Supervision: Click here to enter text. Briefly describe student’s current assignments, i.e. # of individual clients, families, groups, research, macro assignments (agency based policy, research, in-­‐service, case presentations, etc.) Assignment: Click here to enter text. Will there be any additional assignments during this semester or next? Choose an item. If so, describe: Click here to enter text. Will the student have the opportunity to work with the following vulnerable and oppressed populations? Choose an item. Please check all that apply: ☐Adolescents ☐Aging ☐Chemically Dependent ☐Children ☐Developmentally Disabled ☐Domestic Violence Victims ☐Economically Disadvantaged ☐Families ☐Homeless ☐Immigrants ☐Medically compromised ☐Mentally Ill ☐Physically Challenged ☐Veterans ☐LGBTQ 6-­‐Week Assignment 2 II. Educational Goals Please indicate with a check mark which of the following most closely applies to the specific areas of content: ü 1. Significantly low competence (Student demonstrates little knowledge, value or skills) ü 2. Low competence (Student not demonstrating continuous progress) ü 3. Developing/Emerging Competence (Student demonstrates beginning knowledge, value, skill development) ü 4. N/A= Not applicable SERVICE TO CLIENTS Engagement Skills Rating: Choose an item. Listening Skills Choose an item. Interviewing Skills Choose an item. Contracting Skills Choose an item. Psychosocial Assessment Skills Choose an item. Intervention Skills Choose an item. Use of Self Choose an item. Advocacy and Empowerment Skills Choose an item. Knowledge of Entitlements and Resources Choose an item. Program Planning & Development Skills Choose an item. Administration & Management Skills Choose an item. AGENCY FUNCTION Understanding of Agency Function, structure, policies, & procedures Rating: Choose an item. Fulfills administrative (paperwork) responsibilities in a timely manner Choose an item. Collaborates with agency staff Choose an item. Appropriately represents self to client and agency Choose an item. Other, please specify: Click here to enter text. PROFESSIONAL DEVELOPMENT Self-­‐Awareness Rating: Choose an item. Accepts & integrates constructive feedback Choose an item. Prepares an agenda for supervision Choose an item. Understands the function and role of supervision Choose an item. Can evaluate own practice Choose an item. PROFESSIONAL DEVELOPMENT cont’d Takes responsibility for learning needs Rating: Choose an item. Presents self in a professional manner, I.e. dress, punctuality, attendance, etc. Choose an item. Establishes and maintains appropriate boundaries with clients and colleagues Choose an item. Is able to recognize and manage personal values in a way that allows professional values to guide practice Choose an item. Demonstrates effective oral and written communication Choose an item. Research: Reads and evaluates relevant literature Choose an item. III. Field Instructor Comments: Click here to enter text. 6-­‐Week Assignment 3 IV. Educational Plan 1. Is the field Placement meeting the needs of the both the student and agency? Choose an item. 2. Name a few areas from above that the student needs to focus on for the remainder of the semester. I.e. professional development; written communication, group work, etc. • Click here to enter text. • Click here to enter text. • Click here to enter text. • Click here to enter text. Field Instructor Signature: Click here to enter text. Date: Click here to enter a date. Student Signature: Click here to enter text. Date: Click here to enter a date.