The UniveNity ofNort[ Csroliua

at peDrbroke
t_tep4itEedt oI Socirl WorL
BSW Mdterm Evaluation
Neee ofField Student

o',.

Instuctiorrs for Raring Studetus on the 10

Con pelencies in fie First

pa

Jla'7ll{

ol lhe Evoluation:
The 10
rditing
several

The Student has excelled G this

lhe Student has met the

Ga
for Students in this area

The,Snrdent hus not as y

meet the e)ectatons in the near future

s area in the

lear futul

co'mtrtr_mal be made utrder any compelency statmen! if desi*d. plerse be sure to

rndic-ate thos
ares in qhich you think the Studetrt is particulady strong and dlose arcas that
ned improvoEent.
comT ents may be made under any compete[cy staternent. pleese b su, to iodicate those aras
in which
you lhink the Student is pafiicularly shong and thos arcas that rced improvement.
Please give exalaples
for atry area in which the student reoeived a raJing of I or 2.
for the studnt add agency field inshuctor to
is responsible for
ign a grade. The
and bssed on the
wi& the agefty lietd
c.

cot'pctoce

I.l
1.2
1.3
1.4
1.5
1.6

#li

saudent idenaifi"" f,! a professioner social worker and conducts hi'rel7he^erf

siryicesif6ffi

Advocates well for clictrt access to dre

Practics personal rcflecti"n and self-correcrion toEsure
professional development
AEends well to gofessionatibG an<t tounaaries
DmonstEtes paofessional demeanor in appeamnce
Demodtratas Fofessional dernegtor in communic{tion
Uses supervision strd consultation efrectively
Commetrts:

conffi

I
I

,11

4\

na
na

NA

5)

4
4

t5/
)

na
no

CompeteBce ta2:

nractic.2.t

Recomi"..

"J

41 5

oa

na

3
3

'4)

tra

na

2.2
2.3
2.4

I
I

Studert spptig cfi

iudsDetrts-

Coppents:

4.r

Recoldiz*d'.ffi

4.2

rnay oppr$, ma4inalize.

tnd rrower
IIas suffi cimt..rE-^l-l-

eJ

4.3

44
*o.k" ("li"osi*itf,
Commetrts:

;--io ;t"^' -'

."E{aEs rqose

o' she

,4)

na

!5t___stq4glFa*r"oh".*,_-

Un-dersanas*@
oJscfim ination

I""tueaat"@
Commefts:

CoEpetence

Studert

116:

Ilsearch.

engEg]es

ir

Esar-ch-irformed prEctice atrd pmctice_informed

ls skilled at
Is skil
social
Cornments:

Is

skilld

at

util

Comments:

CoDptence

#8:

StudeDt e
to deliver eEective social work servicc$

rld
Is,stilea

atanatyzin@

advatrce social well-beino

ls skilled at collaborating with

oolicv acti.n
Commepts:

coii@G aniitientrforiEtiG

91

Is skillea at

con6loiusi?;""^I;

rnservice derivery and

srvrcer

practr.",;-d;;-;;:

;ttTil:1ff

8""

,9

DA

na

Comhents:

rssoses,itrtervetrs-o"rdo"toG-rtEaifi
a-uGt.miti"",ons,4nd mDDutritis.
I0.l

o+9

4^

to2
10.3
10.4

l0-5

b#

10.6

2
2

3
3

10.7

l0.E

I0.9

2
2
2

3
3
3

tr\

mlo
2

IO.I I

I
I
I

1o.12
10.

r3

Copments:

3
2
2

3
3

na
na

na

o)l'
4
4

4
4
4
4

na

t5l

na
na
na
na

na
da

IE

na

the

Stuaeqt

h;A;ia

+!ee!qi"fi,';do'i"g,bo;.

Number of ClockEoursCo
pt"t

li)

Coemonts/eleboEtion:

igrlatulc ofAgeacy Field

InstDctor

yiff:l?r-#y#$Tt

ffffi:fffi'JJve

disoussed rris ovaruarion wirb

mq and r rrove received

Iagree with fte evaluationI do not agre with evaluafion

Student's Signature

o""

e/nil{

lfthe. Studeot disag.Ees with the

evoluati# u'vqw ruqu rulr uEI dsaseernent
qt disagemetrt in writing and
submit
suDmr! 4
4 copy
copy to boh
bodl the
rr,e ug"""v-i"la-i
a@.nN A-tA,-**:-l:9q,*f
6e
frculty
fieJd direcor. A miting
between
oerween rheq$udent,
fte studenl as,r"y
asencv incmrnr^.
the disagreement.

ri.-'"t".,'*ii"ffi
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