Student Evaluation of Agency
Student Name:______
Student Cohort (please check):_____FULL TIME_____PART TIME
Student E-mail Address:
Agency Name:______
Field Instructor Name:______
Task Supervisor Name:______
Evaluation Year:______
Course: ____ SW 592 (First Placement)___SW 594 (Last Placement)
Please note: If you check “poor” in any area please comment in the “comment section” on the last page.
Competencies: I’ve had opportunities to learn about and to:
1. Demonstrate Ethical and Professional Behavior. / (3) Excellent: provided numerous and multifaceted opportunities.(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
2. Engage in Diversity and Difference in Practice. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
3. Participate in Advancing Human Rights and Social, Economic, and Environmental Justice. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
4. Engage in Practice-informed Research and Research-informed Practice. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
5. Engage in Policy Practice. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
6. Engage with individuals, families, groups, organizations, and communities. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
7. Assess individuals, families, groups, organizations, and communities. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
8. Intervene with individuals, families, groups, organizations, and communities. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
9. Evaluate practice with individuals, families, groups, organizations, and communities. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
Supervision: My Field Instructor:
1. Was available for our scheduled weekly supervision. / (3) Excellent: provided numerous and multifaceted opportunities.(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
2. Supports and enhances what I learn in the classroom. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
3. Was available to me outside of supervision when needed. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
My Task Supervisor:
1. Was available for our scheduled weekly supervision. / (3) Excellent: provided numerous and multifaceted opportunities.(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
2. Supports and enhances what I learn in the classroom. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
3. Was available to me outside of supervision when needed. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
Agency: The Agency:
1. Matches the mission of the MSW program. / (3) Excellent: provided numerous and multifaceted opportunities.(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
2. Valued me as an important part of the team. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
3. Demonstrated a commitment to social, economic and environmental justice. / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
4. Provided adequate resources to me in order to do my work (office apace, phone, etc.). / (3) Excellent: provided numerous and multifaceted opportunities.
(2) Good: Provided optimal opportunities.
(1) Poor: Provided minimal or no opportunities.
If you checked “poor” in any areas above, please document reasons here:
Additional Comments: (e.g. What did you like about this placement? What could be improved? What should future students know about this placement? )
______
Student Name
______
Student SignatureDate
2017