California State University, Long Beach (CSULB)
California State University, Los Angeles (CSULA)
California State University, Northridge (CSUN)
California State University, Dominguez Hills (CSUDH)
California State University, Fullerton (CSUF)
University of California at Los Angeles (UCLA)
University of Southern California (USC)
Department of Social Work
School of Social Work
Department of Social Work
Department of Social Work
Department of Social Work
Department of Social Welfare
School of Social Work
Field Education Learning Agreement
Purpose
This Learning Agreement is based on the premise that each student entering a
graduate program in social work has different educational backgrounds and life
experiences. Therefore, this Learning Agreement provides each student with the
opportunity to participate in planning their individual field educational experience. It
provides a link between educational experience planning and evaluation, while offering
students the opportunity to individualize their learning needs. The Learning Agreement
is used by students and their respective Field Instructors to complete both the mid-year
evaluation and the final evaluation at the end of the academic year. This Learning
Agreement was developed for social work students enrolled in the above listed
universities.
Implementation
All students enrolled in field education are responsible for writing their individual
Learning Agreements in collaboration with their respective Field Instructors. The Field
Faculty Liaisons are available for consultation, as needed. In writing the Learning
Agreement, please follow these guidelines:
1. Begin working on the Learning Agreement at the start of the field placement.
Due dates are listed on each school’s Field Calendar and in the course syllabus.
2. Use part of the time in supervision to discuss the content of the Learning
Agreement.
3. Use the Learning Agreement as a dynamic and flexible instrument. Modifications
and changes in assignments may be indicated during the academic year to
accommodate new opportunities in the field work agency, or to reflect changes in
students’ learning needs. However, any changes must be agreed upon by both
the Field Instructor and the Student, and communicated to the Liaison. Changes
should be written and attached to the original Learning Agreement.
4. Use the Learning Agreement as a guide for ongoing feedback during the course
of the academic year.
5. Section VII will be completed by the Field Instructor. All other sections will be
completed by the student with the collaboration of the Field Instructor.
Notes: This form was intended to be completed electronically and then printed out for signatures. If a
write-on form is desired, please contact the Field Education office.
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Learning Agreement Outline
I. IDENTIFYING INFORMATION
Student Name:
Email:
Phone number:
Foundation Year
Concentration Year
Field Faculty Liaison:
Email:
Phone number:
Field Instructor:
Email:
Phone number:
Preceptor:
Email:
Phone number:
Agency:
Address:
City:
Zip:
II. THE AGENCY AND THE COMMUNITY
(Agency)
A. Describe the agency’s mission:
B. Describe the organizational structure:
C. List the services provided to the community:
D. Describe the general demographics (ethnicity, race, socio-economic status, age) of
the agency’s clients:
(Community)
E. Describe the geographic location of your agency:
F. Describe the general demographics ethnicity, race, socio-economic status, age) of
the community (if different from D above):
G. Describe the community’s need for resources (in addition to what the agency
provides):
H. Describe the community’s perception of the agency:
I. List other agencies to which referrals are made:
J. Who (Field Instructor?) or what (agency brochure?) were your sources of
information:
III.
A.
B.
C.
D.
E.
F.
GENERAL TIME MANAGEMENT
List the days and hours in field placement:
List the day and time that Process Recordings are due:
List the day, time and length of individual field supervision:
List day and time of group supervision, if applicable:
Contact person and phone in Field Instructor’s absence:
List of agency-observed holidays or non-client days:
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G. If the above list of holidays do not coincide with campus holidays, how will these
hours be adjusted to insure the completion of the required field work hours?
IV. FIELD EDUCATION ASSIGNMENTS
Check those learning activities to which the student will be exposed during the field
work placement period.
A. Check all direct practice field education assignments:
Adults
Individuals
Information
Discharge Planning
and Referral
Families
Advocacy
Treatment
Older Adults
Planning
Children
Groups
Diagnostic
Crisis Intervention
Assessment
Adolescents
Community Networking Linkages
Couples
Case Management
Interdisciplinary Team
Meetings
Psychosocial Assessment
Short Term Intervention
Long Term Intervention
Other (specify)
B. Check all macro practice field education assignments:
Task forces
Quality Assurance
Committee Assignments
Grant Writing
Program Development
Multidisciplinary Team Meetings
Consultation
Program Evaluation
Fiscal Budgetary Issues
Case
Agency Staff Meetings
Conferences
Macro Project (specify)
Community Networking Linkages
Other (specify)
C. Check other learning experiences:
Seminars, In-Service Training/Conferences
Other (specify)
V. SELF AWARENESS
A. Identify and discuss you areas of personal strength:
B. Identify and discuss areas in which self-awareness could be enhanced:
VI. STUDENT’S EXPECTATIONS FOR SUPERVISION IN FIELD/INSTRUCTION
A. Describe your expectations of the supervision process:
B. Describe your expectations of yourself in supervision:
C. Describe your expectations of your Field Instructor:
D. Describe your expectations of your Preceptor (if applicable):
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VII. FIELD INSTRUCTOR TEACHING PLAN (To be written by the Field Instructor)
A. Detail your expectations of your student in supervision:
B. How do you structure your weekly field instruction? Briefly describe you teaching
plan. Please include how you plan to maximize diversity in your case assignments for
each student.
C. Describe your plan for use of a preceptor with your student (if applicable). Describe
the preceptor role and your plan for monitoring and evaluating this experience:
VIII. SELF ASSESSMENT AND EDUCATION PLAN IN THE FIVE CORE AREAS
(Please refer to the Comprehensive Skills Evaluation in the Field Manual)
Core Area I: Development of Professional Responsibility and Identity of Social
Work Profession
A. List your strengths:
B. Identify your areas for growth:
C. Describe how you plan to develop your knowledge, skills, and abilities in this Core
Area:
Core Area II: Development of Responsibility as a Learner
A. List your strengths:
B. Identify your areas for growth:
C. Describe how you plan to develop your knowledge, skills, and abilities in this Core
Area:
Core Area III: Development of Knowledge of the Field Work Agency and the
Community
A. List your strengths:
B. Identify your areas for growth:
C. Describe how you plan to develop your knowledge, skills, and abilities in this Core
Area:
Core Area IV: Development of Organization, Work Management, and
Communication Skills
A. List your strengths:
B. Identify your areas for growth:
C. Discuss how you plan to develop your knowledge, skills, and abilities in this Core
Area:
Core Area V: Development of Practice and Intervention Skills
A. List your strengths:
B. Identify your areas for growth:
D. Discuss how you plan to develop your knowledge, skills, and abilities in this Core
Area
Signatures
This Learning Agreement must be signed and dated by the Student, Field Instructor,
and Preceptor (if applicable). Signatures are required before this document can be
submitted to the Field Education Liaison. Signatures acknowledge that each individual
has participated in the development of this agreement, and approved it.
Student Signature
5/12/2008
Date
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______________________________________________________________________
Field Instructor Signature
Date
Preceptor Signature
5/12/2008
Date
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Revisions
Please outline any revisions to the Learning Agreement as they occur and date.
Core Area I: Development of Professional Responsibility and Identity of Social
Work Profession
Core Area II: Development of Professional Responsibility as a Learner
Core Area III: Development of Knowledge of the Field Work Agency and the
Community
Core Area IV: Development of Organization, Work Management, and
Communication Skills
Core Area V: Development of Practice and Intervention Skills
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Orientation Checklist for Social Work Interns
The following items must be discussed in person by the Field Instructor and the Student
to orient the student to the field work agency. Please check each item after it is
reviewed. Both the Student and the Field Instructor must sign and date this Checklist,
indicating that each item has been covered. Please return a copy of this Checklist with
the Learning Agreement.
Agency Overview
Review agency vision and mission/purpose statement
Tour of agency
Introduction to colleagues, support staff, and administration
Review organization structure
Review the role of the agency in relation to the community and it resources
Review security and/or safety procedures and protocol (in the agency and in the
field), including disaster preparedness
Agency Policies and Protocols
Review office procedures, supplies, and provisions
Review telephone and communication/computer utilization, including cell phones
and email
Review intake/admissions/eligibility policy and procedures
Review internal communications
Review parking details
Review mileage policy
Review agency, department, and/or unit meeting schedule
Review client record/charting policies and procedures
Review forms for documentation/accountability
Review regulations regarding confidentiality, release of information, etc.
Review policy regarding HIPAA
Review client fess/payment schedule
Review client emergency protocol
Review child or elder abuse reporting protocol
Review work schedule, including lunch and breaks
Review information/referral policy
Review agency policy regarding harassment
Review agency policy regarding discrimination
Review agency policy regarding the Americans with Disability Act
Review policy regarding OSHA
Review policy regarding risk management and safety plan(s)
Field Instructor/Student Responsibilities
Review expectations for supervision and schedule
Review Process Recording schedule
Review use of preceptor (if applicable)
Review plan for diversity/multi-cultural experiences
Review plan for monitoring of student hours (by both Field Instructor and student)
Review agency training or staff development opportunities
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Review student’s professional and personal safety issues and concerns and
strategies for intervention
Signatures:
Student (sign and print name)
Date
Field Instructor (sign and print name)
Date
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