ࡱ> IKH` bjbjss .0#####D'@#####$$$H'J'J'J'J'J'J'$ )hq+n'&$$&&n'##',',','&##H','&H',',','## Pw]Q~#(&,'H''0',',"',,',,'$0$",'%1%$$$n'n'"' $$$'&&&& ϳԹ Social Work Program Student Evaluation of Fieldwork Placement This form is designed to give interns the opportunity to provide feedback about the supervision they receive during their internship. This information will be useful in discussions with supervisors and will help your faculty instructor evaluate the learning opportunities at various internship sites. 1. Check as many of the following as apply. I had: A place to store materials A permanent desk at which to work An office of my own An office with other people Access to a phone Access to get supplies as I needed them A place to conduct confidential business 2. Comment on the following: To what extent did you feel physically and psychologically part of the agency staff? Were staff members available and willing to provide you assistance? 3. Were you assigned cases, groups, or projects relevant to your learning needs? [ ] Yes [ ] No Comments: 4. Did your work assignments call for a level of skill appropriate to your professional and personal development? [ ] Yes [ ] No [ ] Sometimes Comments: 5. How often were regular, planned supervisory conferences held? [ ] more than one hour per week [ ] one hour per week [ ] less than one hour per week 6. Using the following rating scale, rate the extent to which the supervisory conferences were helpful to your professional development. [ ] very helpful [ ] somewhat helpful [ ] unhelpful Comments/recommendations for change: 7. Please rate your fieldwork instructor using the following scale: 1 = Exceptional 2 = Very Good 3 = Good 4 = Fair 5 = Poor NA = Not Applicable/No Basis Exceptional Poor a. Facilitated the process of integration into the 1 2 3 4 5 NA agency system. b. Discussed and clarified agency policy and 1 2 3 4 5 NA procedures. c. Encouraged and supported responsible 1 2 3 4 5 NA decision making concerning attendance at staff meetings, seminars, and conferences. d. Encouraged and supported self-evaluation 1 2 3 4 5 NA of my work in the agency context. e. Facilitated learning of specific practice skills. 1 2 3 4 5 NA f. Encouraged identification with professional 1 2 3 4 5 NA values and behavior consistent with those values. g. Was clear and consistent about the 1 2 3 4 5 NA expectations of this placement. Exceptional Poor h. Was available if I requested additional 1 2 3 4 5 NA contact and to answer questions and concerns. i. Was aware of academic content and helped 1 2 3 4 5 NA integrate class material with the field experience. j. Shared feedback that recognized areas in which 1 2 3 4 5 NA my skills and knowledge were relatively strong. k. Shared feedback that recognized areas in which 1 2 3 4 5 NA my skills and knowledge needed improvement. l. Recognized and complimented me for 1 2 3 4 5 NA accomplishments or things I did well at the internship. m. Let me know when my performance was not 1 2 3 4 5 NA appropriate or acceptable in certain areas. n. Encouraged me to discuss personal 1 2 3 4 5 NA impressions, reactions, and adjustments to the internship. COMMENTS: Please make any comments or discuss examples which would further clarify or expand on your ratings (e.g., teaching methods, areas of strengths and weaknesses, suggestions for change, etc.). 8. Would you recommend that students be placed in this agency in the future? If no, why not? Signature: ____________________________ $%NO   0 3 U X p s HKLT$29Y\eQR}:?fgcdѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵѵhCJOJQJaJhn(h>*CJOJQJaJhn(hCJOJQJaJh z,hCJOJQJaJh z,h5CJOJQJaJG%OP~  + P k wwwwwww%  x HX( dh]^`gd"  x HX( ]^`gd  x HX( ]gd $da$gd$ & X( h8xH!a$gd      w  8@ dh]^`gd"  x HX( ]^`gd  $ < ^ _ "#HIJK"  x HX( h]^h`gd"  x HX( ]^`gdKl   !L]L^`gd lL]Lgd P]^Pgd$ P]^Pgd$ Pdh]^Pgd#$  x HX( h]^h`gd v[56 lX dh^`gd% & 8 x HX( ]^`gd lX ^`gd lX dh^`gd 6*+|i/0 lX ddh^d`gd lX Ldh]L^`gd lX ^`gd lX dh^`gd"OPZ>?   lX gd hvlX ]gd hlX @@]gd lX Ldh]L^`gd lX ^`gd02:Y  hhn(h>*CJOJQJaJhn(hCJOJQJaJhCJOJQJaJ    `pqrstuvwxygd$$ & 8 x HX( P]^Pa$gd $ & 8 x HX( ]a$gd lX gd,1h/ =!"#$% D`D NormalCJOJQJ_HmH sH tH DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k@(No List 0%OP~ +Pkw$<^_"#HIJKv[ 5 6 * + |   i / 0 " O P Z>?     `pqrstuvwxy0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000%OP~ +Pkw$<^_"#HIJKv[ 5 6 * + |   i / 0 " O P Z>?     `pqrstuvwxyh0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z03h0z00h0z0.h0z0%h0z0%h0z0$h0z0"@0h00h00h0z0$h00%h00%h00%h00%h00%h00%h00%h00%h00%h00%h00"@0h00h00h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0h0!  K6 8@0(  B S  ?jLj"jD =*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsplace e  w}\d  + , }   o v  # % `k`o33333333333333333333@`b @UnknownGz Times New Roman5Symbol3& z Arial5& zaTahomaS PalatinoBook Antiqua"qhzFzFYJXYJX$24KK2qHX)?2$Skidmore College Social Work Program SkidmoreUser SkidmoreUserOh+'0 0< \ h t(ϳԹ Social Work ProgramϳԹUser Normal.dotϳԹUser1Microsoft Office Word@@PF~@PF~YJ՜.+,0 hp  ϳԹXK %ϳԹ Social Work Program Title  "#$%&'()*+,-./012345679:;<=>?ABCDEFGJRoot Entry F@gQ~LData 1Table!,WordDocument.0SummaryInformation(8DocumentSummaryInformation8@CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q