9.7: Supervisor Evaluation of Student
STUDENT EVALUATION BY AGENCY SUPERVISOR
FIELD WORK PRACTICUM
NAME OF STUDENT____________________________________________________
AGENCY________________________________________________________________
AGENCY SUPERVISOR __________________________________________________
PERIOD COVERED BY EVALUATION FROM_____________ TO_____________
NUMBER OF HOURS WORKED
Please evaluate the experience of the above-named student in terms of your agency or organization. This evaluation should be discussed with the student and signed by the supervisor, College Field Work instructor, and the student. In Section A, please identify the kind of work and experiences your student intern performed during his/her placement in your agency. In section C, please tell us how well your intern did in acquiring competencies.
I have read this evaluation.
DATE Agency Supervisor_____________________________________
DATE Student______________________________________________
DATE College Instructor _____________________________________
SECTION A.
Describe the student's role and tasks in the agency or organization. Be specific about roles played.
SECTION B.
Please rate the student’s performance in the following areas using the scale below.
|
A Outstanding |
B Good |
C Average |
D Needs Improvement |
F Poor |
|---|
___ 1. The student understood agency operations.
___ 2. The student understood the agency's purpose and role in the Human Service system.
___ 3. The student accepted supervision and constructive criticism.
___ 4. The student was reliable such as arriving when expected.
___ 5. The student completed assignments on time.
___ 6. The student participated as a member of the team.
___ 7. The student related well to clients of diverse backgrounds.
___ 8. The student was respectful of others' points of view.
___ 9. The student demonstrated good communication skills.
___ 10. The student was able to ask for help.
___ 11. The student was able to keep personal information of the client confidential.
___ 12. The student demonstrated an understanding of client self-determination.
___ 13. The student showed respect for the client's personal values.
___ 14. The student demonstrated a recognition of the client’s worth and uniqueness.
SECTION C.
Please check yes or no as to whether the student completed the tasks below. If you answered yes, please rate their performance.
|
DID THE STUDENT |
NO |
YES |
Rate their performance 1 2 3 4 5 Poor Excellent |
|---|---|---|---|
|
Complete basic intakes |
|
|
1 2 3 4 5
|
|
Instruct others in Activities of Daily Living |
|
|
1 2 3 4 5
|
|
Assist in case management |
|
|
1 2 3 4 5 |
|
Facilitate groups |
|
|
1 2 3 4 5 |
|
Maintain professional records |
|
|
1 2 3 4 5 |
|
Participate in treatment/service planning |
|
|
1 2 3 4 5 |
|
Participate in Goal Planning |
|
|
1 2 3 4 5 |
|
Conduct interviews |
|
|
1 2 3 4 5 |
|
Conduct crisis interviews |
|
|
1 2 3 4 5 |
|
Make good referrals |
|
|
1 2 3 4 5 |
|
Plan and implement recreational activities with clients |
|
|
1 2 3 4 5 |
|
Communicate professionally with clients |
|
|
1 2 3 4 5 |
SECTION D
Give a general summary of what you saw as this student's strengths and areas where you feel the student could improve (please utilize the back of this sheet if needed).