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Initial Report

Last Modified: 06/15/2014
1.
Bryan Dan St. Clair County CMH ACT team Bill Slusher Kim Shepherd
Student: Agency: Agency Field Instructor(s): Faculty Advisor:
Total Responses 1
Statistic Value
2. Please Check One:
1 BSW 0 0%
2 BSW WOW 1 100%
3 MSW Foundation Year 0 0%
4 MSW Advanced Year 0 0%
Total 1
# Answer Bar Response %
Min Value 2
Max Value 2
Mean 2.00
Variance 0.00
Standard Deviation 0.00
Total Responses 1
Statistic Value
3. Please check and complete all that apply.
1 Student has received agency orientation and work space has been assigned. 1 100%
2 Student has completed _______hours to date (Enter hours below): 1 100%
3 Student is actively engaged in weekly supervision. 1 100%
4 Learning Plan has been completed and submitted to the Field Instructor and Faculty Advisor. 1 100%
5
Process Recordings or PRACSIS have been reviewed by Field Instructor and submitted to the Faculty Advisor (students should check with assigned Faculty Advisor to find out
the number of Process Recordings or PRACSIS required).
0 0%
# Answer Bar Response %
257.50
Student has completed _______hours to date (Enter hours below):
Min Value 1
Max Value 4
Total Responses 1
Statistic Value
4. Please describe any areas of strength or concern in regard to the student’s performance and/or the availability of required learning assignments.
Engagement with people in services, enthusiasm, seeking variety of tasks for learning
Text Response
Total Responses 1
Statistic Value
5. This is the Field Placement Midterm Evaluation for (Student First Name) (Student Last Name).COMPETENCY AREAS 1 – 11*
1 Identify as a professional social worker and conduct oneself accordingly. 1 0 0 1 1.00
2 Apply social work ethical principles to guide professional practice. 1 0 0 1 1.00
3 Apply critical thinking to inform and communicate professional judgments. 1 0 0 1 1.00
4 Engage diversity and difference in practice. 1 0 0 1 1.00
5 Advance human rights and social and economic justice. 1 0 0 1 1.00
6 Engage in research-informed practice and practice-informed research. 1 0 0 1 1.00
7 Apply knowledge of human behavior and the social environment. 1 0 0 1 1.00
8 Engage in policy practice to advance social and economic well-being and to deliver effective social work services. 1 0 0 1 1.00
9 Respond to contexts that shape practice. 1 0 0 1 1.00
10 Engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities. 1 0 0 1 1.00
11 Analyze the impact of the urban context on a range of client systems, including practice implications. 1 0 0 1 1.00
# Question PROGRESS NO PROGRESS NO OPPORTUNITY Total Responses Mean
Min Value 1 1 1 1 1 1 1 1 1 1 1
Max Value 1 1 1 1 1 1 1 1 1 1 1
Mean 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Variance 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Standard
Deviation
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Total
Responses
1 1 1 1 1 1 1 1 1 1 1
Statistic
Identify as a
professional
social worker
and conduct
oneself
accordingly.
Apply social
work ethical
principles to
guide
professional
practice.
Apply critical
thinking to inform
and
communicate
professional
judgments.
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
advance 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.
Analyze the impact of
the urban context on a
range of client systems,
including practice
implications.
6. *If there is a Competency Area in which the student has not met minimum performance expectations to date, a plan of action must be noted below. If
there will not be an opportunity to address a competency area, please state that.
Text Response
Total Responses 0
Statistic Value
7. This is the Field Placement Midterm Evaluation for (Student First Name) (Student Last Name). FIELD INSTRUCTOR SECTION
1 Recommend: 1 0 1 1.00
# Question PROGRESS NO PROGRESS( FOR MID-TERM) Total Responses Mean
Min Value 1
Max Value 1
Mean 1.00
Variance 0.00
Standard Deviation 0.00
Total Responses 1
Statistic Recommend:
8. Comments
Text Response
Total Responses 0
Statistic Value
9. **Please note: By typing my name below, I certify that I have reviewed the document, completed my portion and agree with the content.
Bill Slusher 2/21/2014
**Field Instructor( agency- based supervisor): Date **Task Supervisor (if applicable): Date
Total Responses 1
Statistic Value
10. This is the Field Placement Midterm Evaluation for (Student First Name) (Student Last Name).If you aren't able to complete the Midterm Evaluation
with the student present, have you discussed it with the student?
1 Yes 1 100%
2 No 0 0%
Total 1
# Answer Bar Response %
Min Value 1
Max Value 1
Mean 1.00
Variance 0.00
Standard Deviation 0.00
Total Responses 1
Statistic Value
11. If the student is present, please have them complete this section. STUDENT SECTION
1 I.... 0 0 0 0.00
# Question Agree Disagree with the evaluation. State reasons below Total Responses Mean
Min Value -
Max Value -
Mean 0.00
Variance 0.00
Standard Deviation 0.00
Total Responses 0
Statistic I....
12. Comments
Text Response
Total Responses 0
Statistic Value
13. **Please note: By typing my name below, I certify that I have reviewed the document, completed my portion and agree with the content.
**Student: Date
Total Responses 0
Statistic Value