SWRK 3150 BSW Field Evaluation Form

SWRK 3150 BSW Field Evaluation Form

FIELD EVALUATION

B.S.W. Field Placement

SWRK 3150

LEARNING CONTRACT AND SKILLS EVALUATION

IDENTIFYING INFORMATION
Field Placement Days: Mon. ☐ Tues. ☐ Wed. ☐ Thurs. ☐ Fri. ☐ Sat. ☐ Sun. ☐
TIME (example: 8 a.m. – 4 p.m.; 10 a.m. – 2 p.m.): Click here to enter text.
Reflective journal frequency (e.g., daily, weekly, bi-weekly, monthly): Choose an item.
Day(s) and time(s) of weekly field supervision: Choose an item.
Student / Click here to enter text. / Field Instructor*
U of M Email / Click here to enter text. / Email / Click here to enter text. /
Primary Phone / Click here to enter text. / Primary Phone / Click here to enter text. /
Faculty/Field Liaison / Click here to enter text. / Agency Mentor*
(if applicable) / Click here to enter text. /
Email / Click here to enter text. / Email / Click here to enter text. /
Primary Phone / Click here to enter text. / Primary Phone / Click here to enter text. /
Agency / Click here to enter text. / Contact Name
(if applicable) / Click here to enter text. /
Address / Click here to enter text. / Email / Click here to enter text. /
Fax # / Click here to enter text. / Primary Phone / Click here to enter text. /

*Note:A Field Instructor must possess a social work degree and is appointed by the University to supervise student. Agency Mentor is the onsite person who does not hold a social work degree but it is directly supervising the student and works in collaboration with the Field Instructor.

☐ Distance Delivery BSW Field Program
Joan Churley, Field Coordinator
Distance Delivery Social Work Program
Faculty of Social Work
University of Manitoba

Phone: 204.474.6812
Toll Free: 1.800.432.1960 Ext: 6812
Fax: 204.474.7594 / ☐ Fort Garry & Inner City Field Programs
Kelly Scott, Field Coordinator
Fort Garry & Inner City Social Work Programs
Faculty of Social Work
University of Manitoba

Phone: 204.474.8300
Fax: 204.474.7594 / ☐ Northern Social Work Program
Janet Brady, Field Coordinator Northern Social Work Program
Faculty of Social Work
University of Manitoba

Phone: 1.204.677.1456
Fax: 1.204.677.4110

Please indicate below which Field Coordinator (Program) you are submitting this Evaluation form to:

LEARNING CONTRACT

The Learning Contract is an important tool in the field instruction process. Its purpose is to assist in making learning goals and expectations explicit. The student develops it, collaboratively with the field instructor, and in consultation with the field liaison. It is a working document, meant to be flexible and dynamic. It can be assessed on an ongoing basis throughout the field placement and modified if required to acknowledge changing needs and goals.

The Learning Contract is to be completed prior to each of the five (5) skills sets identified in this form. In other words, the Learning Contract flows throughout the Evaluation Form. There can be several learning objectives for any section. An example of the Learning Contract is found below.

1. Professionalism/Ethical Standards

The student identifies as a professional and conducts self in a professional manner. The student is able to articulate social work ethics and principles that will guide professional practice.
LEARNING CONTRACT
Objectives / Activities / Timeline
Familiarize self with agency mandate. /

• Reviewing agency policy and procedure manuals and other relevant documents.

/ First month of placement.
Become aware of any Agency documentation tools and ensure my written work is professional /

• Ask field instructor if I could attend any training on agency tools
• Seek feedback from my field instructor

/ Throughout placement
Review and practice within the CASW Code of Ethics standards /

• Discuss ethical issues with instructor

/ Ongoing /

EVALUATION

One purpose of the Evaluation Form is to provide a standardized instrument that can provide a consistent guide for field instructors and students to measure student performance. A pass/fail grade is intended to encourage students to risk themselves in their professional development without risking a lower numerical grade. The assessment of the student’s performance is meant to be progressive. In SWK 3150 the student is expected to demonstrate a basic level of skills and abilities and a markedly stronger skills and abilities upon completion of SWRK 4120.

Each section contains a number of attributes that are to be evaluated. An explanation for assessing knowledge/ability/skills at a 1, 2, 3, or a 4 can be found on the next page. Boxes titled “Example” follow each attribute. Examples are mandatory whenever a student is assessed as not meeting expectations or when a student requires further development in a particular skill set. Examples can also be made in other instances as well.

There are three (3) grade recommendations to be considered. A Pass indicates that the student has met expectations and has demonstrated skills at a 3 & 4 level. A Fail indicates that the student has failed to meet expectations. A Fail Incomplete indicates that the student is required to continue in SWRK 3150 for a defined period, as contracted with the student, Field Instructor, and Faculty Field Liaison.

To assess a skill set as a 1, the student does not meet expectations; as a 2, the student needs development; as a 3, the student meets expectations and as a 4, the student consistently integrates theory and skills. Examples for the four (4) assessments levels follow on the next page. It is also acceptable to use not applicable (N/A) or not observed (N/O) if a student has not had the opportunity to demonstrate or practice this skill set, or if the Field Instructor has not been able to evaluate a particular attribute of a skill set.

1)Does Not Meet Expectations: The student fails to demonstrate the necessary skills and abilities. Some
examples are:

• Demonstrates tardiness and unreliability (not showing up or notifying his or her instructor when late, absent or ill)
• Demonstrates a lack of initiative and professionalism
• Demonstrates a lack of self-awareness
• Does not accept guidance and feedback
• Does not complete assigned tasks
• Unaware of own values, biases, and needs
• Demonstrates a lack of appreciation for or lack of awareness of agency policies and procedures
• Weak communication skills (verbal, non-verbal)

Action: Field Instructor and Field Liaison will complete the formal Learning Contract addendum, or discuss termination. / 2)Needs Development: The student demonstrates potential for
growth in his or her professional role, but in an inconsistent
manner. Some examples are:

• Inconsistent focus on learning goals
• Tasks not always completed in a timely manner
• Beginning to demonstrate an understanding of the links between classroom knowledge and practice
• Identifies his or her own values and biases but not always mindful of these in interactions or interventions with others
• Understands Agency practices and procedures but does not always follow them
• Documentation is not always clear, objective or factually written
• Beginning to demonstrate achievement towards goals as outlined in Learning Contract

Action: Field Instructor and Field Liaison will review on a regular basis the skills that have been identified for development.
3)Meets Expectations: The student would receive a “3” when s/he demonstrates identified skills on a regular basis. Examples include, but are not limited to:

• Identifies who the client (system) is and can suggest possible interventions
• Aware of personal strengths and is able to identify areas for personal and professional growth in supervision
• Able to link theory when assessing possible interventions
• Engages in self-evaluation with a focus to transfer learning from one situation to another
• Effectively uses a range of interpersonal communication skills
• Provides documentation which is factual, objective, and purposeful. Assessments completed in timely manner
• Is prepared for supervision and actively seeks direction, when appropriate
• Consistent demonstration of achievement towards goals as outlined in Learning Contract

/ 4)Integrates Theory and Skills: The student would receive a “4”
when s/he demonstrates competence or exceptional skills on a
consistent basis. Examples include, but are not limited to:

• Forms strong working relationships with client systems and can apply a range of interventions
• Is able to critically analyse use of self when working with clients, with a plan on how to improve
• Practice is grounded in theory. Consistently considers the impact of personal and professional values on one’s practice
• Engages in Ongoing evaluation of interventions
• Demonstrates concrete and significant of achievement towards goals as outlined in Learning Contract

Note: Client can refer to individuals, families, community groups, and/or organizations

1 / 2 / 3 / 4
Not Meeting Expectations / Needs Development / Currently Meets Expectations / Integrates Theory and Skills / N/A
(Not Applicable) / N/O
(Not Observed)

1. Professionalism/Ethical Standards

The student identifies as a professional and conducts self in a professional manner. The student is able to articulate social work ethics and principles that will guide his or her professional practice.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
1.1Understands and adheres to agency confidentiality guidelines. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.2Completes documentation in a timely, organized, concise fashion, and follows proper procedures in storage of electronic information. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.3Demonstrates professional writing skills. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.4Demonstrates knowledge of CASW Code of Ethics and provincial/territorial social work standards, including social media policy. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.5Takes initiative and responsibility for one’s own learning. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.6Conducts oneself in a professional manner at all times. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.7Maintains clear and appropriate boundaries with clients, co-workers and collaterals. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.8Other / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
You must make summary comments at Midterm (including additions and changes to the learning activities and objectives):
Click here to enter text.
You must make summary comments at Final (including recommendations for learning goals and activities for SWRK 4120 Learning Contract):
Click here to enter text.
1 / 2 / 3 / 4
Not Meeting Expectations / Needs Development / Currently Meets Expectations / Integrates Theory and Skills / N/A
(Not Applicable) / N/O
(Not Observed)

1. Assessment and Intervention Skills in Practice

The student demonstrates effective use of self as a beginning professional, as well as essential communication, assessment, intervention, and documentation skills.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
2.1Demonstrates effective engagement skills by using a range of interpersonal communication skills (e.g., reflection, clarification, paraphrasing, and questioning). / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.2Communicates respectfully and effectively both verbally and non-verbally through the use of language, appropriate eye contact, body language, (e.g., sitting attentively at an angle, open posture, leaning forward, eye contact and relaxed body). / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.3Reviews confidentiality guidelines and student roles with clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.4Empowers clients to build on their skills and strengths. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.5Demonstrates reliability, effective time management and preparation for
meetings. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.6Uses agency tools effectively to collect and assess information. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.7Works collaboratively with clients in identifying relevant issues and in
mutual planning, contracting and goal setting. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.8Assesses client readiness for change based on a number of factors (e.g., access to resources, potential barriers, motivation level and past history. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.9Works effectively with clients who display a range of beliefs, emotions and behaviours. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.10 Demonstrates awareness of how issues of race, class, age, sexual
orientation, ableism, geographical factors and gender can impact upon case planning. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.11Understands a range of social work interventions at the individual, family group, organizational, community and societal levels. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.12Assists clients in exploring and identifying social networks and social supports of potential benefit. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.13Completes referrals to appropriate community resources on behalf of client and with client’s consent. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.14Establishes rapport and effective working relationships with agency personnel and representatives of committees, working groups, and other agencies. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.15Effectively researches and assists in developing and/or facilitating groups. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.16Understands the termination process and prepares client and self for closure, well in advance. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.17Other / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
You must make summary comments at Midterm (including additions and changes to the learning activities and objectives):
Click here to enter text.
You must make summary comments lease make comments at Final (including recommendations for learning goals and activities for SWRK 4120 Learning Contract):
Click here to enter text.
1 / 2 / 3 / 4
Not Meeting Expectations / Needs Development / Currently Meets Expectations / Integrates Theory and Skills / N/A
(Not Applicable) / N/O
(Not Observed)

1. Reflective Capacity and Critical Analysis

The student demonstrates ability to engage in constructive discussions and reflections of self, clients and service delivery.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
3.1Understands and articulates one’s own values, assumptions and/or biases and potential impact upon practice with clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
Click here to enter text.
3.2Identifies and discusses ethical dilemmas in the context of client self-determination and the Social Work Code of Ethics. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.3Seeks and begins to apply constructive and critical feedback to further learning and improve professional effectiveness. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.4Identifies and uses theoretical knowledge to guide practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.5Explores social work practice at the individual, family, and community levels. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.6Demonstrates the ability to take risks by integrating acquired learning in the field placement site. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.7Demonstrates awareness of clients’ relationship to their environments (e.g., social, physical, spiritual, natural). / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.8Awareness of how one’s own social location (e.g., race, economic position social status, sexual orientation, gender, age, ableism) influences one’s practice with clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.9Other / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
You must make summary comments at Midterm (including additions and changes to the learning activities and objectives):
Click here to enter text.
You must make summary comments at Final (including recommendations for learning goals and activities for SWRK 4120 Learning Contract):
Click here to enter text.
1 / 2 / 3 / 4
Not Meeting Expectations / Needs Development / Currently Meets Expectations / Integrates Theory and Skills / N/A
(Not Applicable) / N/O
(Not Observed)

1. Fostering and Promotion of Human Rights and Social Justice

Student demonstrates an awareness of global issues and anti-oppressive practice.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
4.1Understands issues of inequity in society (e.g., diversity, oppression, discrimination, power, ethno-culture, human diversity, and privilege). / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.2Recognizes that each person has basic human rights, such as freedom, safety, privacy, an adequate standard of living, health care, and education. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.3Respects and advocates for the rights of others and brings to the attention of the field instructor any human rights concerns. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.4Recognizes the importance of practising from a culturally sensitive perspective, seeking consultation, if required to effectively meet clients’ needs. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.5Understands and describes the power structure and lines of authority within the agency and the impact upon roles, responsibilities and practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.6Other / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
You must make summary comments at Midterm (including additions and changes to the learning activities and objectives):
Click here to enter text.
You must make summary comments at Final (including recommendations for learning goals and activities for SWRK 4120 Learning Contract):
Click here to enter text.
1 / 2 / 3 / 4
Not Meeting Expectations / Needs Development / Currently Meets Expectations / Integrates Theory and Skills / N/A
(Not Applicable) / N/O
(Not Observed)

1. Integration of Policy and Practice

Student is aware of the links between policy and social work practice.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
5.1Understands and complies with agency policies and procedures. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.2Reflects on how policy impacts practice at the agency. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.3Understands the role of research and clinical evaluation in social work practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.4Demonstrates awareness of Canadian social welfare programs. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.5Researches, drafts and prepares policy proposals for the agency. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.6Understands the purpose and process accompanying needs assessments and community asset-mapping in working with stakeholders to identify community needs. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.7Understands the importance of using a strengths-based perspective in working community groups and partner organizations. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.8Assists, with direction from instructor, in helping to identify project goals, activities, time frames, consent requirements and means of evaluation, in partnership with community stakeholders. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.9Is able to prepare preliminary outlines, drafts, briefs, reports, presentations, and workshop materials, when required. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.10Understands the importance of using appropriate methods of technology and communication, including social media, to distribute research findings in accordance with agency confidentiality policy. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.11Other / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
You must make summary comments at Midterm (including additions and changes to the learning activities and objectives):
Click here to enter text.
You must make summary comments at Final (including recommendations for learning goals and activities for SWRK 4120 Learning Contract):
Click here to enter text.

Learning Contract Signatures Date