Field Education
Student Learning Contract and Evaluation
(for CSD student only)
Learning Abilities Page
Identify as a Reflective Professional Social Worker / 5
Advocate for Social, Economic and Environmental Justice / 7
Apply Social Work Methods / 9
Uphold Social Work Values and Ethics / 11
Integrate Cultural, Economic, and Global Diversity / 13
Think Critically about Theory and Research Knowledge / 15
Communicate Effectively / 17
Develop as a Social Work Leader / 19
The Learning Contract/Evaluation will be completed accurately and in its entirety and submitted to the Field Education Department for assessment and review by the date of ______. Failure to do so may result in a grade of “No Pass.”
Signatures:
603-CSD
Sign by all parties at time of conference / Conference with Field Faculty Advisor
Date______
Student ______
Field Instructor ______
Task Supervisor (if applicable) ______
Field Faculty Advisor ______
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
SASS 603(CSD)Field Education
Student Learning Contract and Evaluation
Student Information
Student Name: / ID:
Best Contact Number: / Email:
Field Placement Information
MSASS Field Faculty Advisor:
Agency:
Agency Code:
Agency Contact #’s: / Telephone: / Fax:
Address:
City: / State: / Zip Code:
Field Instructor:
Telephone: / E-mail:
Task Supervisor:
(if applicable)
Telephone: / E-mail:
(if applicable)
Program Information
Concentration:
Student Status
Term / Year
Start Date: / End Date:
Evaluation Due Date:
ALL SECTIONS OF THE LEARNING CONTRACT/EVALUATION MUST BE TYPED, WRITTEN IN A PROFESSIONAL FORMAT AND PROOFREAD BEFORE SUBMISSION.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
(SASS 603-CSD) - To Be Completed By The Student In Collaboration
With Field Instructor/Task Supervisor
I.Orientation to the Agency: Please describe the orientation provided by the field site:
II.Educational Plan: Identify all assignments for the field period and the abilities that the assignment is intended to focus on / develop. 603-CSD
III.Assignment #1:
Assignment #2:
Assignment #3:
1
Assignment #4:
Assignment #5:
Assignment #6:
IV.Supervisory Structure and Process:
A.Plan for weekly field instruction:
B.Plan for Task Supervision (if applicable):
C.Learning Strategies for Supervision Sessions: Please list or describe learning strategies (e.g., process recordings, observation, role play, review of tapes of own work).
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Rank / Rating Scale / Rating Scale Definitions/ Demonstrates high level of competence / Consistently Demonstrates/engages in exceptional competent performance at the foundation/advanced level of social work practice. Activities are consistently managed in a competent manner, and the student exhibits high levels of relevant knowledge, skills and abilities.
/ Demonstrates competence / Demonstrates competent performance at the foundation/advanced level. Activities are managed in a competent manner and the student exhibits appropriate levels of relevant knowledge, skills and abilities.
/ Developing competence / Developing or beginning to perform at the foundation/advanced level. Some activities are managed in a competent manner. The student has not demonstrated consistent levels of performance of relevant knowledge, skills and abilities. Additional training may be necessary.
/ Demonstrates inconsistent competence / Demonstrates inconsistent performance at the foundation/advanced level. Activities are managed with some difficulty. The student has not demonstrated performance of relevant knowledge, skills and abilities consistent with the foundation/advanced level. Corrective actions and additional training are required.
/ Does not demonstrate competence / Does not demonstrate performance at the foundation/advanced level of social work practice. Activities are not managed in a competent manner and the student exhibits substandard levels of knowledge, skills and/or abilities. Corrective action and additional training are required.
Month / Field Hrs / PD Hrs / total hours
Total hours banked from last semester
Total Hours for semester
/ SASS 603:
288 Hours in agency PLUS / 12 hours additional Professional development (e.g. MSASS Colloquia, community or agency based training) / Total Hours = 300
Foundation SASS 602 Learning Contract/Evaluation 9/25/2018Page 1
Identify as a Reflective Professional Social Worker–603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Utilizes strengths, weaknesses in order to comply with the mission and values of the organizational structure. / Describe what you learned from this task
(complete at the end of the field period)
2.Recognizes the contributions of skills, knowledge, values and resources through professional collaboration.
3.Understands individual biases and vulnerabilities with a reflective awareness of their impact on practice.
4.Seeks and utilizes appropriate supervision and consultation to enhance social work practice.
5.Respects the mutual impact of the change process on workers and clients.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Identify as a Reflective Professional Social Worker - 603 CSD(Please type text in the box below)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Identify as a Reflective Professional Social Worker / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Identify as a Reflective Professional Social Worker / Rating Total / Rating Average
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Advocate for Social, Economic and Environmental Justice–603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Facilitates collaborative work with clients and communities to reflect a global perspective.
2.Analyze policies that influence the field practice setting and their impact on individuals, families, groups and communities.
3.Utilizes research data, evidence based practice, and course materials to educate and inform others.
4.Engage in activities to advocate for vulnerable populations.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Advocate for Social, Economic and Environmental Justice - 603-CSD(Please type text in the boxesbelow)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Advocate for Social, Economic and Environmental Justice / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Advocate for Social, Economic and Environmental Justice / Rating Total / Rating Average
Apply Social Work Methods–603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Engages stakeholders and utilizes a collaborative process toward the realization of goals.
2.Maps community needs and assets; implements relevant community change strategies.
3.Designs and applies tools and process skills to promote community development.
4.Demonstrates skills in fundraising, grant development, financing, budget analysis, cost-savings and cost cutting, strategic partnerships and social entrepreneurship.
5.Assess effectiveness and develop strategies to improve programs.
6.Recognizes the importance of termination and its impact on future work.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Apply Social Work Methods–603-CSD(Please type text in the box below)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Apply Social Work Methods / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Apply Social Work Methods / Rating Total / Rating Average
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Uphold Social Work Values and Ethics - 603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Assumes responsibility for the quality of practice in compliance with NASW and relevant state Codes of Ethics.
2.Anticipates and clarifies conflicting values and ethical dilemmas.
3.Identifies and separates personal issues and values from professional practice.
4.Recognizes the ethical obligation to practice within one’s scope of competence.
5.Applies a framework for ethical decision-making to resolve ethical dilemmas.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Uphold Social Work Values and Ethics – 603-CSD(Please type text in the box below)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Uphold Social Work Values and Ethics / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Uphold Social Work Values and Ethics / Rating Total / Rating Average
Integrate Cultural, Economic, and Global Diversity –603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Anticipate and identify areas of practice which require the development of new cultural competence.
2.Develop an awareness of global social work issues and demonstrate its impact on your social work practice.
3.Engages client systems in culturally sensitive social work interventions to build on their inherent strengths.
4.Analyze and work to eliminate barriers that interfere with access to and use of service.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Integrate Cultural, Economic, and Global Diversity –603-CSD(Please type text in the box below)
((Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Integrate Cultural, Economic, and Global Diversity / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Integrate Cultural, Economic, and Global Diversity / Rating Total / Rating Average
Think Critically about Theory and Research Knowledge –603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Demonstrates mastery of advanced course content in an area of specialization to include theory, methods, research, and practice and/or program evaluation.
2.Evaluates practice effectiveness by systematically observing relevant outcomes and integrating feedback from supervisors, classroom instructors, peers, clients, community members, and stakeholders.
3.Analyze and apply various models of evidence based practice and research in your area of specialization.
4.Articulate the process and defend the selection of various intervention strategies at an advanced level of practice.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Think Critically about Theory and Research Knowledge –603-CSD(Please type text in the box below)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Think Critically about Theory and Research Knowledge / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Think Critically about Theory and Research Knowledge / Rating Total / Rating Average
Communicate Effectively –603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Demonstrates competence in professional verbal communication.
2.Demonstrates competence in professional written communication.
3.Demonstrates competence in the use of technology to meet organizational mandates.
4.Demonstrates professional objectivity in negotiation and conflict mediation.
5.Applies the principles and skills inherent in professional collaboration
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Communicate Effectively –603-CSD (Please type text in the box below)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Communicate Effectively / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Communicate Effectively / Rating Total / Rating Average
Develop as a Social Work Leader - 603-CSD
Rating Scale / rating4 / Demonstrates high levels of competence / 2 / Developing competence / 0 / Does not demonstrate competence / Student / Field Instructor
3 / Demonstrates competence / 1 / Demonstrates inconsistent competence
Tasks: / Relevant Assignment(s) / Implementation plan
(complete before 603 CSD field conference) / Describe what you learned from this task
(complete at the end of the field period)
1.Demonstrates autonomy in fulfilling field responsibilities.
2.Uses innovation and creativity in social work practice to promote sustainable changes within the organization, the community and the profession.
3.Values flexibility in the face of changing human services, social and global contexts.
4.Demonstrates understanding of applicable state licensure requirements; pursues continued professional growth and development opportunities.
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Develop as a Social Work Leader–603-CSD(Please type text in the box below)
(Student)
- Describe the integration of theory into practice.
- Identify your educational goals for advanced practice.
to be completed by student at end of the field period
Ability Overall Rating (Average of Student task Ratings)
Develop as a Social Work Leader / Rating Total / Rating Average
(Field Instructor)
- Assess the student’s performance with respect to this ability.
to be completed by field Instructor at end of the field period
Ability Overall Rating (Average of Field Instructor task Ratings)
Develop as a Social Work Leader / Rating Total / Rating Average
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1
Overall Rating of Student’s
Competency for 603(CSD)
Abilities / Overall RatingST / FI
Identify as a Reflective Professional Social Worker
Advocate for Social, Economic and Environmental Justice
Apply Social Work Methods
Uphold Social Work Values and Ethics
Integrate Cultural, Economic, and Global Diversity
Think Critically about Theory and Research Knowledge
Communicate Effectively
Develop as a Social Work Leader
TOTAL
Student Comments:
Field Instructor’s Comments:
/ Signature of Field Instructor Date
/ Signature of Student Date
/ Signature of Task Supervisor (if applicable) Date
/ Signature of Field Faculty Advisor Date
Advanced SASS 603 CSD Learning Contract/Evaluation 9/25/2018Page 1