FACULTY OF APPLIED SOCIAL SCIENCES

DEPARTMENT OF DEVELOPMENT STUDIES

APPENDIX 1

FORM ONE

TRAINING ORGANISATION

NAME OF INSTITUTION: ZIMBABWE OPEN UNIVERSITY

REGION :……………………………………………………………………………

ADDRESS :……………………………………………………………………………..

E-MAIL :…………………………………………………………………………….

FACULTY :…………………………………………………………………………….

DEPARTMENT :…………………………………………………………………………….

COURSE :…………………………………………………………………………….

COURSE DURATION :FROM……………………………..TO…………………………………..

HOST ORGANISATION REPRESENTATIVE……………………………………………………..

REGIONAL PROGRAMME CO-ORDINATOR/LECTURER……………………………………..

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FORM TWO

TRAINEE INFORMATION

SURNAME :………………………………………………………FORNAME(S)………………………………………

DATE OF BIRTH :…………………………………………………….NATIONAL I.D NO…………………………………

PIN NUMBER :………………………………………………………

CONTACT

Permanent Home Address Contact Address

…………………………………………………. ………………………………………………………..

…………………………………………………. ………………………………………………………..

…………………………………………………… ………………………………………………………….

…………………………………………………… ………………………………………………………….

Email Address : ……………………………………………………………….

PHONE :………………………………………………………………….

NEXT OF KIN :………………………………………………………………….

Contact Address :……………………………………………………….Relationship…………………………………..

………………………………………………………..

…………………………………………………………

…………………………………………………………

PHONE :………………………………………………………….

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FORM THREE

HOST ORGANISATION

NAME OF ORGANISATION:…………………………………………………………………………………………

ADDRESS :…………………………………………………………………………………………

…………………………………………………………………………………………

………………………………………………………………………………………….

………………………………………………………………………………………….

E-MAIL ……………………………………………PHONE………………………………………………………

CONTACT PERSON’S

Period of On-Job-Training: From…………………………………………To………………………………

NAME:…………………………………………SIGNATURE…………………………DATE……………………….

DESIGNATION…………………………………………………..STAMP…………………………………………….

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 RECORD OF WORK DONE
(To be completed by the trainee...Logbook)
Date Work Carried Out Objective Trainee’s Comments

TRAINEE……………………………………………………SIGNATURE…………………………………………..DATE……………………….
SUPERVISOR…………………………………………….SIGNATURE…………………………………………...DATE………………………
COLLEGE REP……………………………………………..SIGNATURE…………………………………………..DATE………………………

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FORM SIX

PRACTICUM SITE SUPERVISOR EVALUTION

……………………………………… ………………………………………….
(Student’s Name) (Supervisor’s Name)

……………………………………… ………………………………………….
(Practicum Site) (Dates of Practicum)

Please use the following scale to evaluate your practicum site experience and supervisors.

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree
n/a=Not Applicable

Introduction to Setting

_____________________ I was given a tour of the practicum/site.

---------------------------------My supervisor introduced me to other staff when I began the

practicum.
………………………….. My supervisor discussed ethical and legal issues I began the
practicum.

Comments…………………………………………………………………………………………..

……………………………………………………………………………………………………..

………………………………………………………………………………………………………

Issues in the Setting

………………………..The environment was safe, stimulating and conducive to professional

growth.

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FORM EIGHT

PRACTICUM STUDENT END OF SEMESTER REPORT

(TO BE COMPLETED BY THE HOST SUPERVISOR)

Student’s Name …………………………… Supervisor’s Name ……………………………..

Practicum Site ………………………………………Dates …………………………………….

Please use the following scale to evaluate your practicum student in the questions below.

1=Far Below Expectations – needs much improvement, a concern

2=Below Expectations – needs some improvement to meet standards

3=Meets Expectations – acceptable, meets standards at average level

4=Above Expectations-performs above average

5=Far above Expectations-performs well beyond average

n/a=Not Applicable or not enough information to form a judgment

Basic Work Requirements (on time, on site)

--------------- Arrives on time consistently

-------------- Uses time effectively

------------- Informs supervisor and makes arrangements for absence

-------------- Completes required total number of hours or days on site

------------ Is responsive to norms about clothing, language, etc on site

Comments:-------------------------------------------------------------------------------------------------------

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Ethical Awareness and Conduct

-------------------------------- Knowledge of general ethical guidelines

------------------------------- Knowledge of ethical guidelines of practicum site

------------------------------- Demonstrates awareness and sensitivity to ethical issues

----------------------------- Maintains confidentiality of clients

--------------------------- Behaviour is consistent with ethical guidelines

-------------------------- Demonstrates professional conduct

------------------------- Consult with others about ethical issues if necessary

Comments: ------------------------------------------------------------------------------------------------------

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Knowledge and Learning

--------------- Knowledgeof development setting at begging of practicum

--------------- Knowledge of Development at end of practicum/internship

-------------- Knowledge level of client population at beginning of practicum

-------------- Knowledge level of client population at end practicum

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------------ Knowledge of Development approach at end of practicum

----------- Ability to prioritize Community problems

----------- Ability to conceptualize cases and human problems

----------- Ability to develop appropriate development plans

---------- Actively seeks new information from supervisor or staff

--------- Receptive to learning when new information is offered

---------- Ability to apply new information in work setting

---------- Understanding of development theories

………………………………………. ………………………………….
(Supervisor’s Signature) (Date)

……………………………………… …………………………………
(Student’s Signature) (Date)

Stamp

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 FACULTY OF APPLIED SOCIAL SCIENCES
DEPARTMENT OF DEVELOPMENT STUDIES
BSDS 402 PRATICUM ASSESSMENT FORM
(Academic supervisor)

SECTION A
NAME OF STUDENT
NAME OF INSTITUTION
NAME OF PLACEMENT DEPARTMENT
NAME OF ACADEMIC DEPARTMENT
NAME OF PLACEMENT SUPERVISOR
NAME OF ACADEMIC SUPERVISOR
: .....................................................
: .....................................................
: .....................................................
: .....................................................
: .....................................................
: .....................................................

SECTION B
 On a scale of 1 to 5, please assess the progress and ability of the student to date
 Ratings 1- Unsatisfactory, 2- Satisfactory, 3- Competent, 4 – Highly Competent,
5 - Outstanding or Excellent
For items that do not apply, please put not applicable (N/A)

Development of personal Attributes 1 2 3 4 5

I Punctuality

Ii Self-Confidence

Iii Self Discipline and General Conduct

Iv Reliability

V General Commitment to work

Development of Interpersonal Skills 1 2 3 4 5

I Compliance with authority

Ii Sensitivity to needs of others

Iii Intiative and creativity

Iv Teamwork spirit and co-operation in general

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V Sense of responsibility

Development of Professional Competence 1 2 3 4 5

I Demonstrates effective verbal skills

Ii Demonstrates effective writing skills

Iii Makes decisions based on analysis of facts

Iv Speed and accuracy of work

V Resilient and consistent in the face of

challenges
Development of technical/administrative skills (25 Marks)
specific to the placement institution

Specify and skills required by your organisation and assess the student’s mastery of these out of 25
marks
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General comments on the student’s performance and progress to date

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Total Points Scored

Total possible Points 100

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Placement Supervisor............................................... Date...............................................
Academic Supervisor................................................. Date................................................
Student...................................................................... Date...............................................

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