STUDENT NAME
AGENCY NAME:
SocW 525 Advanced Community-Centered Integrative Practice
Quarterly Evaluation of Student Learning and Competency
(Expandable Word versions from the Practicum Website can be saved aas a template to your computer to work on electronically)
Requirements for Credit:
 A separate evaluation cover sheet must accompany this document, with signatures of student
and practicum instructor(s), verification of all credit hours completed, and recommendations for
credit. Cover sheets are individualized for each student from the practicum database and
distributed to the practicum instructors in Summer Quarter and to student mailfiles in other
quarters. Blank cover sheets are available in the Practicum Manuals online and in hard copy.
 All sections of this narrative evaluation must be completed by students and instructors, with
the PI also rating the student’s competencies. The student must demonstrate satisfactory
progression in practicum, according to Practicum Competency Criteria, to receive credit.
 All immunizations must be completed or in process for a student to receive clearance from
Hall Health (myshots@u.washington.edu), required for credit.
KEY TO RATING SCALE for Practicum Instructors to Rate Students:
Instructions: Please note the level of competence/performance for each skill/behavior using the
following scale. Increasing competency over the course of practicum is an expectation for students..
N = No opportunity yet to evaluate; will be addressed in subsequent quarter(s)
1 = Area of concern: needs improvement
2 = Achievement of competency in process
3 = Competent at MSW Advanced student level
4 = Exceeds competency expected of an MSW Advanced student at this stage of development
1. SOCIAL JUSTICE: To demonstrate a commitment to the promotion of social justice, through
one’s own work and that of the larger social work profession, and apply advanced knowledge and
principals of multiculturalism and empowerment to social change efforts in one’s practice.
Student's description of site-specific activities this quarter:
Student's description of areas of competency and areas for growth:
Practicum Instructor's narrative evaluation of student learning in this area for this quarter:
Practicum Instructor’s Rating of Student’s Level of Competency in Each Area:
The Student Has:
a. Demonstrated ability to apply effective, empowering and culturally
appropriate change strategies in one’s everyday practice, toward the goal of
promoting social justice and behavioral and social change.
b. Demonstrated cultural competency through the ability to collaborate
effectively across differences of race, ethnicity, socioeconomic status, gender,
age, sexual orientation or ability.
N
1
2
3
4
2
c. Demonstrated ability to work closely with constituents to create and support
change efforts that effectively increase the social, cultural, political and
economic empowerment of vulnerable and marginalized populations.
2.
POLICY SERVICES: To demonstrate advanced knowledge and skills in critical analysis of the
sociopolitical factors that shape policy and services formation in one’s area of practice or setting, in
analyzing and influencing existing policies and services and in advocating for change in policies,
services and practices locally, nationally and globally.
Student's description of site-specific activities this quarter:
Student's description of areas of competency and areas for growth:
Practicum Instructor's narrative evaluation of student learning in this area for this quarter:
Practicum Instructor’s Rating of Student’s Level of Competency in Each Area:
The Student Has:
N
1
2
3
4
a. Demonstrated ability to apply advanced social work principles, evaluate the
efficacy of social policies, programs and interventions in promoting justice and
preventing/alleviating economic and social inequalities.
b. Demonstrated ability to analyze the structural/societal sources and uses of
power and authority
c. Demonstrated ability to promote social justice through ethical use of power
and authority in advocating for and with vulnerable and marginalized
constituents.
3. ADVANCED COMMUNITY-CENTERED INTEGRATIVE PRACTICE: To articulate the theories,
knowledge of human behavior, and research evidence that informs one’s practice, apply these mindfully in one’s
work with diverse constituents, and demonstrate advanced skills through a variety of professional roles across
multi-levels of practice.
(PLEASE REFER TO COMPLETED 525 CONTRACT WHILE COMPETING TO ADDRESS INDIVIDUALIZED
SPECIALIZED PLAN)
Student's description of site-specific activities this quarter:
Student's description of areas of competency and areas for growth:
Practicum Instructor's narrative evaluation of student learning in this area for this quarter:
Practicum Instructor’s Rating of Student’s Level of Competency in relevant areas below:
The Student Has:
a. Demonstrated mastery in the use of effective interpersonal relationships in
practice, characterized by warmth, genuineness, empathy, and cultural
awareness.
b. Demonstrated advanced skills in ethical decision-making processes and
ability to resolve value conflicts in one’s professional practice, consistent with
NASW Code of Ethics.
c. Demonstrated ability to apply advanced knowledge and skills related to
human behavior in the social environment when conducting theory-based
N
1
2
3
4
3
assessments and interventions with diverse populations.
d. Demonstrated the capacity for on-going leadership in multiethnic and
multicultural groups (refugee or immigrant, tribes, other) applying knowledge
of planning and evaluation processes for service delivery; and employing
empowerment strategies to build constituent autonomy.
e. Demonstrated effective relational and communications skills, with and
between groups, including ability to identify and analyze power differentials to
ensure that all positions are taken into account.
f. Demonstrated ability to build coalitions and collaborative relationships that
impact services, involving constituents in identifying the strengths and barriers
inherent in community or policy change.
g. Demonstrated ability to apply social change efforts in one’s practice to
structural dynamics and inequalities of society, both locally and globally.
h. Demonstrated ability to apply social change efforts in one’s practice to
structural dynamics and inequalities of society, both locally and globally.
i. Demonstrated skill in representing the profession and the agency in
community change efforts, utilizing effective teaching and training
methodologies.
j. Demonstrated ability to apply financial, organizational, administrative
processes to the delivery of services
4. RESEARCH AND EVALUATION: To demonstrate the advanced knowledge and skills required to assess
the differential needs of diverse constituents, plan and implement evidence-based interventions in collaboration
with constituents, and critically evaluate, monitor, and continuously refine one’s practice using appropriate
research and evaluation methods.
Student's description of site-specific activities this quarter:
Student's description of areas of competency and areas for growth:
Practicum Instructor's narrative evaluation of student learning in this area for this quarter:
Practicum Instructor’s Rating of Student’s Level of Competency in Each Area :
The Student Has:
a. Demonstrated ability to use empirically-based knowledge and culturally
sensitive methodologies in planning interventions and monitoring practice
effectiveness;
b. Demonstrated ability to develop and test hypotheses regarding service
delivery variables which may have positive or negative impact on desired
outcomes;
c. Demonstrated ability to identify and apply outcome indicators which can
reliably measure the effects of service delivery variables on desired outcomes.
N
1
2
3
4
5. PROFESSIONAL GROWTH, DEVELOPMENT, AND RESPONSIBILITY: To demonstrate
professional values, skills and behavior through a self-reflective understanding of and adherence to the
NASW Code of Ethics and other relevant professional standards.
Student's description of site-specific activities this quarter:
Student's description of areas of competency and areas for growth:
Practicum Instructor's narrative evaluation of student learning in this area for this quarter:
4
Practicum Instructor’s Rating of Student’s Level of Competency in Each Area :
The Student Has:
a. Demonstrated ethical practice based on the NASW Code of Ethics, and
resolution of ethical dilemmas across levels of practice and involving relevant
constituents.
b. Demonstrated self awareness, including the ability to differentiate between
presenting personal, professional, or organizational positions, and prevent
personal values and biases from interfering with professional decisions.
c. Demonstrated respect for the rights of others to maintain perspectives and
positions different from one’s own and support the right of self-determination.
d. Demonstrate professional behavior and professional growth, including
communication skills and an investment in learning.
e. Demonstrates professional responsibility by being courteous to clients and
N
1
2
3
4
colleagues; by being punctual and dependable; and by organizing and prioritizing work
responsibilities effectively.
6.
AUTONOMOUS PRACTICE: To achieve a level of competency such that, with self-monitoring
and use of informed consultation, one can practice autonomously in one’s area of concentration.
Student's description of site-specific activities this quarter:
Student's description of areas of competency and areas for growth:
Practicum Instructor's narrative evaluation of student learning in this area for this quarter:
Practicum Instructor’s Rating of Student’s Level of Competency in Each Area :
The Student Has:
a. Demonstrated ability to integrate and apply advanced knowledge, values,
and skills enabling independent judgment in professional practice .
b. Demonstrate ability to use supervisory suggestions and guidance from the
practicum instructor, consultants, advisory groups, boards and community
policy groups in preparation for and to monitor autonomous practice
c. Demonstrated ability to incorporate critical and reflective thinking in
autonomous practice, continuous self evaluation and learning.
N
1
2
Brief Summary Comments
Required from both Student and Practicum Instructors
Student's Overall Self-Assessment of Learning this Quarter:
Practicum Instructor's Overall Assessment of Student's Progress this Quarter:
3
4
5
Priorities for Next Quarter
Student Statement of Priorities for next quarter (at final quarter, summarize further education needed):
Practicum Instructor Statement of Priorities and areas of emphasis for next quarter (or future education):
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