This evaluation is being completed at the completion of: Fall Semester OR Spring Semester □ □ The student successfully completed her/his learning plan Fall Semester: NA Spring Semester: Yes OR No (explain) □ □ □ Please check one of the following at the final evaluation. At the midterm evaluation do NOT complete this section. This intern excelled in field placement by performing above expectations for interns. If an appropriate position were open at this agency, for a beginning level social worker, this intern would be considered among the top candidates for this position. This intern has met the expectations of the field placement. This intern is ready for beginning level social work practice. This intern is not yet ready for beginning level social work practice. This intern is not yet ready for beginning level social work practice, and has demonstrated serious problems in performance, and perhaps should be encouraged to pursue another major. Comments/elaboration: Strengths: Limitations: ______________________________________________ ______________ Signature of Task/Agency Supervisor Date ______________________________________________ ______________ Signature of Field Instructor (if different than above) Date The following section should be completed by the intern: My agency supervisor and Field Director, or designee, have discussed this evaluation with me, and I have received a copy. My agreement or disagreement follows:
This evaluation is being completed at the completion of: □ Fall Semester OR □ Spring Semester The student successfully completed her/his learning plan Fall Semester: □ NA Spring Semester: □ Yes OR □ No (explain) Please check one of the following at the final evaluation. At the midterm evaluation do NOT complete this section. This intern excelled in field placement by performing above expectations for interns. If an appropriate position were open at this agency, for a beginning level social worker, this intern would be considered among the top candidates for this position. This intern has met the expectations of the field placement. This intern is ready for beginning level social work practice. This intern is not yet ready for beginning level social work practice. This intern is not yet ready for beginning level social work practice, and has demonstrated serious problems in performance, and perhaps should be encouraged to pursue another major. Comments/elaboration: Strengths: Limitations: ______________________________________________ ______________ Signature of Task/Agency Supervisor Date ______________________________________________ ______________ Signature of Field Instructor (if different than above) Date The following section should be completed by the intern: My agency supervisor and Field Director, or designee, have discussed this evaluation with me, and I have received a copy. My agreement or disagreement follows:
sw-field-manual-appendix-msw4-msw-clinical-learning-plan-and-evaluation.docx