Spring Semester Final Evaluation SW 5040 Foundation Field Practicum – This page must be submitted to MSW Field office. Email signed form to Student Name: Faculty Liaison: □Credit □No □RD Field Credit (Report Delayed) * Instructor’s recommendation: *Attach approved plan for completion Field Signature Date Instructor’s □Credit □No Task recommendation: Credit Supervisor’s Task Signature Date Supervisor’s I have had an opportunity to review my evaluation with my field instructor and (check one): □I □I agree disagree □Please check if you are providing a written response. Copies of the written response are provided to the Field Instructor, Faculty Liaison, and Field Coordinator. Signature Date Intern’s □Credit □No □RD Faculty assigned grade: Credit (Report Delayed) Liaison’s Faculty Signature Date Liaison’s Comments:
Spring Semester Final Evaluation SW 5040 – Foundation Field Practicum This page must be submitted to MSW Field office. Email signed form to Student Name: Faculty Liaison: Field Instructor’s recommendation: □Credit □No Credit □RD (Report Delayed) * *Attach approved plan for completion Field Instructor’s Signature Date Task Supervisor’s recommendation: □Credit □No Credit Task Supervisor’s Signature Date I have had an opportunity to review my evaluation with my field instructor and (check one): □I agree □I disagree □Please check if you are providing a written response. Copies of the written response are provided to the Field Instructor, Faculty Liaison, and Field Coordinator. Intern’s Signature Date Faculty Liaison’s assigned grade: □Credit □No Credit □RD (Report Delayed) Faculty Liaison’s Signature Date Comments:
sw5040_foundation_learning_plan_evaluation_rev2018_ms_word.docx