BSW Practicum Evaluation Form

BSW Practicum Evaluation

Professionalism

Values and Ethics

Critical Thinking

Diversity

Social and Economic Justice

Research Informed Practice

Human Behavior and Social Environment (HBSE)

Policy

Shaping Practice

Engage, Assess, Intervene and Evaluate

Additional Comments

Identify with the social work profession, it's mission, core values, and conduct oneself accordingly:

Apply social work ethical principles to guide professional practice:

Apply critical thinking to inform and communicate professional judgements:

Engage diversity and difference in practice:

Advance human rights and social and economic justice:

Engage in research-informed practice and practice-informed research:

Apply knowledge of human behavior and the social environment:

Engage in policy practice to address social and economic well-being and to deliver effective social work services:

Respond to contexts that shape practice:

Engage, assess, intervene and evaluate with individuals, families, groups, organizations, and communities:

BSW Practicum Evaluation
Please check one:

Mid-Term Evaluation BSW (SWK405PL) Final Evaluation BSW (SWK405PL)
Evaluation date:

Month Day Year
Student name:

First Name Last Name
Student's email address:
Start date:

Month Day Year
End date:

Month Day Year
Placement site:
Field Instructor:
Field Liaison:
Cumulative hours:
160 hours needed
Total Clients:
Recommended Grade:
Letter grade for BSW

Please refer to the Practicum Internship Learning Goals and Plan and use the following criteria to rate the student.

You will find bulleted qualifiers under each of the ten competencies. Please note that the bullets listed are suggestions to highlight the behavior of your student. Keep in mind that the rating should reflect the student’s progress at this point in the overall internship. If the student’s internship experience does not include tasks or activities related to the competency circle NA. Please complete the questions at the end of the evaluation. No further write-up is necessary. After you and the student have reviewed the evaluation, sign it and submit it to the field office:

0	Demonstrates no competency in this area
1	Demonstrates minimal competency, little knowledge or skill, limited evidence of growth or change, rarely demonstrates progress on tasks and behaviors, and takes little initiative for learning.
2	Developing competence with assistance, with some coaching or prompting demonstrates some skill, marginal competency working towards improvement, beginning level of skill development, needs continued practice and assistance, progress on tasks and behaviors is inconsistent, inconsistently takes initiative for learning.
3	Emerging competency, demonstrates the ability to independently apply skills in simple situations, moderate competency, demonstrating ongoing progress, adequate performance just needs more practice, takes initiative for learning.
4	Demonstrates the competency to begin independent social work practice, demonstrates the ability to apply skills in complex situations, consistent growth and change, demonstrates the ability to complete assigned tasks and activities, takes full responsibility for learning
NA	Does not relate to the student’s internship experience or not sufficient experience to evaluate skill level.

Additional Comments
Identify the methods used to evaluate the student’s performance (example: process recording,observation, etc.)
Identify the student's strengths
Identify the area(s) where the student needs improvement
What is the plan to address the area(s) needed for improvement?
Summarize the student’s performance, overall, as it relates to these competencies.
Thanks for completing this form. A copy of your evaluation will be sent to the student.
Supervisor's email:
Signature

Clear
Should be Empty:

	0	1	2	3	4	N/A
A. Distinguish, appraise and integrate multiple sources of knowledge, including research-based knowledge and evidence informed practice wisdom
B. Analyze models of assessment, prevention, intervention, and evaluation
C. Demonstrate effective oral and written communication in working with individuals, families, groups, organizations, communities, and colleagues

	0	1	2	3	4	N/A
A. Understand the forms and mechanisms of oppression and discrimination
B. Advocate for human rights and social and economic justice
C. Engage in practices that advance social and economic justice

A. Advocate for client access to the service of social work

B. Practice personal reflection and self-correction to assure continual professional development

C. Attend to professional roles and boundaries

D. Demonstrate professional demeanor in behavior, appearance, and communication

E. Engage in career-long learning

F. Use Supervision and consultation

	0	1	2	3	4	N/A
A. Use practice experience to inform scientific inquiry
B. Use research evidence to inform practice

	0	1	2	3	4	N/A
A. Utilize conceptual frameworks to guid the process of assessment, intervention and evaluation
B.. Critique and apply knowledge to understand person and environment

	0	1	2	3	4	N/A
A. Analyze, formulate, and advocate for policies that advance social well-being
B. Collaborate with colleagues and clients for effective policy action

	0	1	2	3	4	N/A
A. Continuously discover, appraise, and attend to changing locales, populations, scientific, and technological developments, and emerging societal trends to provide relevant services
B. Provide leadership in promoting sustainable changes in service delivery and practice to improve the quality of social services

	0	1	2	3	4	N/A
A. Substantively and affectively prepare for action with individuals, families, groups, organizations, and communities
B. Use empathy and other interpersonal skills
C. Develop a mutually agreed-on focus of work and desired outcomes