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FoundationInternshipIMidTermEvaluation‐SW7007

LSU School of Social Work

MID-TERM EVALUATION

FOUNDATION INTERNSHIP I - SW7007

STUDENT’S NAME: AGENCY : DATE:

LCSW SUPERVISOR: TASK SUPERVISOR

(IF APPLICABLE):

FACULTY LIAISON:

This evaluation consists of three sections: (1) Student Progress, (2) Professional Behavior Skills, and (3) Overall

Progress at Mid-Semester.

It is recommended that the Field Instructor and student individually complete this evaluation, and

then complete and sign the final copy together. The Field Instructor's evaluation should incorporate input of the task supervisor

(and other agency staff when appropriate).

Please check one response for each item:

1) Was evaluation completed with student’s input?



Yes  No

2) Was evaluation completed with input from other agency staff?

If yes, please list:____________________________________



Yes  No

SIGNATURES:

This is to certify that I have read and received a copy of this evaluation, that I understand I have the right to disagree in writing

with evaluation of my performance, and that such a statement will be appended to this evaluation.  Yes, statement attached.

_____________________________________________ _________________________

Student Date

_____________________________________________ _________________________

LCSW Supervisor Date

____________________________________________ _________________________

Task Supervisor (

if applicable) Date

_____________________________________________ _________________________

Faculty Liaison Date

_______ _________

Field Office Initials

Please submit the final signed copy to the faculty liaison who will review, sign, and submit the completed evaluation to the Field Office for filing.

FoundationInternshipIMidTermEvaluation‐SW7007

SECTION I: STUDENT PROGRESS ON FIELD COMPETENCIES

This section evaluates the student’s progress in developing skills to build Foundation knowledge and competencies

as outlined on the learning plan. Using the following scale, circle the number that best indicates student's level of

attainment of each the learning competency areas and note any identified strengths and areas that need improvement

at mid-point in the learning experience. The midterm is an opportunity to evaluate if student is on track to meet the

required competency or to address any areas of concern.

UTE 1 2 3

Unable to evaluate:

Student has not yet had an

opportunity to begin

working on this competency

Unacceptable:

Student has not demonstrated

any awareness, knowledge or

skill development in this

competency area

Needs Improvement:

Student inconsistently

demonstrates awareness,

knowledge or skill

development in this

competency area.

Acceptable:

Student is consistently

performing and

demonstrating competency at

an acceptable or above

average level

Note: "Client" may be more broadly than an individual to include groups, communities, and/or organizations.

BEGINNING COMPETENCY EVALUATED Rating Comments:

Developing understanding of social work ethics and professional

behavior

UTE 1 2 3

Demonstrating beginning ability to recognize diversity and difference

in the practice setting

UTE 1 2 3

Showing beginning awareness of advance human rights and social,

economic, and environmental justice and impact on clients

UTE 1 2 3

Beginning skills to engage in practice-informed research and

research-informed to impact on services

UTE 1 2 3

Beginning understanding of policy impact on agency structure and

services at micro, mezzo and macro levels.

UTE 1 2 3

Demonstrating beginning skills interacting and engaging with

Individuals, Families, Groups, Organizations, and Communities

UTE 1 2 3

Demonstrating understanding of assessment tools and skills to use

with Individuals, Families, Groups, Organizations, and Communities

UTE 1 2 3

Beginning understanding of interventions utilized with Individuals,

Families, Groups, Organizations, and Communities

UTE 1 2 3

Beginning awareness of client and agency evaluation practices with

Individuals, Families, Groups, Organizations, and Communities

UTE 1 2 3

SECTION II: PROFESSIONAL WORK SKILLS

This section evaluates the extent to which the student has demonstrated important professional work habits. Using

the following scale, circle the number that best indicates student’s performance for each professional work habit:

1 2 3

Unacceptable

Concerns regarding performance in this area

Needs Improvement

Inconsistent performance in this area

Acceptable

Students performance in on target in

this area

Work Skills Mid-Term Comments:

Student adheres to expected schedule and hours of internship 1 2 3

Student informs instructor when tardy or absent 1 2 3

Student meets agreed upon agency deadlines 1 2 3

Student is appropriately attired 1 2 3

Student maintains collegiate attitude towards all agency staff. 1 2 3

FoundationInternshipIMidTermEvaluation‐SW7007

SECTION III: SUMMARY

Please marks your overall mid-term evaluation of the student's learning progress as it is related to the field

competencies:

Please circle appropriate rating:

1 2 3

Overall performance is unacceptable Overall performance is acceptable

with some reservations

Overall performance is acceptable

Please complete the next section only if the student received a rating of 2 or below in any section of the

evaluation. This will provide a clear plan of action to address the specific behavior(s), specific tasks or

steps to address concerns.

 Identify the expected improvement from the student in concrete terms to improve their competency in the

identified area:

 Identify the time frame by which the improvement(s) is to occur:

 Identify impact to the student learning progress if the desired behavior change does not occur:

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