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COLLEGE OF SOCIAL WORK MSW PROGRAM FIELD PLACEMENT RATING FORM This rating form is to be completed by the MSW STUDENT following the end of each semester. Field work rating is for:   Semester: * Select One Fall Spring Summer I Summer II     Year: * 2006 2007 2008 2009 Enrolled in (Select only one):   Foundation Field Placement (SOWK 781/782)   Advanced Field Placement (SOWK 783/784 or SOWK 785/786) Please circle the appropriate number on the scale for each item and respond to the questions at the end. The rating scale has 5 points ranging from low (1) to high (5) 1 = Unsatisfactory 2 = Marginal 3 = Satisfactory 4 = Good 5 = Superior INSTRUCTOR / PRECEPTOR RATING If you have both a MSW Field Instructor and a Preceptor (usually a non-MSW assigned to the student as the day-to-day task instructor at the agency), please complete a separate rating form for each. Please list only the name of the person you are rating  Instructor:  First Name:  Last Name:  Preceptor:  First Name:  Last Name: Agency:   Instructor: 1 2 3 4 5    1. The instructor's competence as a professional role model    2. The instructor's effective use of the supervisory conference    3. The instructor's accessibility to the student    4. The instructor's ability to assess the student and provide regular, accurate feedback    5. The instructor's ability to prepare a quality written evaluation    6. The instructor's skill in sharing clear expectations of the performance by the student    7. The instructor's effort to provide a variety of learning experiences    8. The instructor's ability to focus learning experiences on the learning objectives of the student    9. The instructor's ability to link the field experiences with the content of the classroom courses    10. The instructor's ability to deal in a flexible and creative fashion with unexpected occurrences      AGENCY RATING: 1 2 3 4 5    1. The agency's receptivity to students    2. The agency's innovativeness in involving students in services    3. The competence level of the agency social work staff    4. The flexibility of the agency (rules, structure, etc.)    5. Physical setting of the agency    6. Openness of the agency to examination by the student    7. Accessibility of the resources of the agency to the student    8. Availability of a variety of professionals for learning    9. Ability of the agency to provide a range of learning experiences    FIELD PLACEMENT RATING FORM   Instructor: 1. Would you recommend this instructor to another social work student? Yes No      Why or why not? (All printing of the comment boxes confined to the box size).   2. What type of student do you believe would work best with this instructor?     AGENCY: 1. Would you want to work in this agency? Yes No      Why or why not?      2. Would you recommend this placement to another social work student? Yes No    3. If yes, should it be a 1st or 2nd year student?     GENERAL REACTIONS: 1. Identify three of your most productive and interesting learning experiences.      2. Identify any obstructions or problems which interfered with your learning.      3. Provide your overall reaction to the field instructor -- his/her style of instruction, level of relationship with the student, etc.      4. Provide your overall reaction to the agency setting -- general skill level of the overall staff, level of service offered, etc.        FIELD EVALUATION OF THE STUDENT: 1. As a field student do you believe you received a fair evaluation? Yes No    2. Did you expect to receive any 1 or 2’s on your evaluation? Yes No       If you would like to discuss this form, please call the Director of Field Education at 803-777-5293.
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