MIDTERM EVALUATION

This form is to be completed by the Field Instructor and discussed with student. It will
automatically be sent to the Faculty Advisor once it is completed online.
Student:

Sam Pedri

Agency:

East China School District

Agency Field Instructor(s):

Linda Bruckner

Faculty Advisor:

Kim Shepard

Please Check One:

X

BSW
BSW WOW
MSW Foundation Year
MSW Advance Year

Q3 Please check and complete all that apply.

X Student has received agency orientation and work space has been assigned.
X Student has completed 35.5 hours to date.
X Student is actively engaged in weekly supervision.
X Learning Plan has been completed and submitted to the Field Instructor and Faculty Advisor.
X 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).

Please describe any areas of strength or concern in regard to the students

performance and/or the availability of required learning assignments.

Sam has progressed on her goals in the learning plan. She has developed a positive
relationship with her students. She has gained insight into the function of behaviors.
She is working on student behavior plans.

Instructions for completing the mid-term evaluation: Please evaluate students

performance halfway through the semester by indicating Progress, No Progress, or No
Opportunity. Please reference the students Learning Plan specific practice outcomes
to determine the rating.
Performance rating scale based on the (11) competencies:
PROGRESS Student met performance expectation and/or is exhibiting
progression to meet expectations
NO PROGRESS Student did not meet performance expectations
NO OPPORTUNITY There was not an opportunity to meet expectations

COMPETENCY AREAS 1 11

Identify as a professional social worker and conduct oneself accordingly.

PROGRES
S

Apply social work ethical principles to guide professional practice.

PROGRES
S

Apply critical thinking to inform and communicate professional judgments.

PROGRES
S

Engage diversity and difference in practice.

PROGRES
S

Advance human rights and social and economic justice.

PROGRES
S

Engage in research-informed practice and practice-informed research.

PROGRES
S

Apply knowledge of human behavior and the social environment.

PROGRES
S

Engage in policy practice to advance social and economic well-being and to

deliver effective social work services.

PROGRES
S

Respond to contexts that shape practice.

PROGRES
S

Engage, assess, intervene, and evaluate with individuals, families, groups,

organizations, and communities.

PROGRES
S

Analyze the impact of the urban context on a range of client systems, including
practice implications.

PROGRES
S

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.
++
In the section below, please provide an Overall Rating of Progress or No Progress for
the students performance, as indicated by the rating that is most frequent of the
eleven (11) competencies. All parties are required to sign the midterm evaluation to
indicate that they have discussed the evaluation, even if the student does not agree
with the evaluation.

FIELD INSTRUCTOR SECTION

Recommend:

PROGRESS

Comments:
Sam has done a good job in developing social work skills in the school setting. Staff
and students respond to her in a very positive manner. She has developed good
working relations with students and staff. She is a pleasure to have around.
**Please note: By typing my name below, I certify that I have reviewed the document,
completed my portion and agree with the content.
(Bruckner, Linda): Linda Bruckner Feb 5, 2015 1:25 PM
Field Instructor (agency-based supervisor)

STUDENT SECTION

I...

Agree with the evaluation.

Comments:
**Please note: By typing my name below, I certify that I have reviewed the document,
completed my portion and agree with the content.
By signing you will submit Midterm FIASC information to the assigned faculty
advisor from the Wayne State University School of Social Work. Once the form is
completed you will not be able to modify your responses.
(Pedri, Samantha): Samantha Pedri Feb 24, 2015 2:19 PM
Student

(Kim Shephard): Kimberly Shephard FL Feb 8, 2015 2:14 PM

Faculty Advisor