MIDTERM EVALUATION

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

Roxanne Rodriguez
National Council onAlcoholism and Drug Dependence, Greater
Detroit Area

Agency Field
Dr. Benjamin A. Jones
Instructor(s):
Faculty Field Liaison:
Dr. Van Camp
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 132 hours to date.
X Student is actively engaged in weekly supervision.
Learning Plan has been completed and submitted to the Field Instructor and Faculty Field
X
Liaison.
Process Recordings or PRACSIS have been reviewed by Field Instructor and submitted to the
X Faculty Field Liaison (students should check with assigned Faculty Field Liaison 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.
Roxanne, is intuitive, committed, and dependable. She demonstrates awareness and genuine
concern for people.

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.
Apply social work ethical principles to guide professional practice.
Apply critical thinking to inform and communicate professional judgments.
Engage diversity and difference in practice.
Advance human rights and social and economic justice.
Engage in research-informed practice and practice-informed research.
Apply knowledge of human behavior and the social environment.
Engage in policy practice to advance social and economic well-being and to
deliver effective social work services.
Respond to contexts that shape practice.
Engage, assess, intervene, and evaluate with individuals, families, groups,
organizations, and communities.
Analyze the impact of the urban context on a range of client systems,
including practice implications.

PROGRESS
PROGRESS
PROGRESS
PROGRESS
NO
OPPORTUNITY
PROGRESS
PROGRESS
PROGRESS
PROGRESS
PROGRESS
NO
OPPORTUNITY

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.
The student has not had ample opportunity to demonstrate progress in some of the compentency
areas. However, going forward there will be more opportunities to demonstrate that skill.
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.

Recommend:
Comments:

FIELD INSTRUCTOR SECTION

PROGRESS

Student is dependable, and thoguhtful. Provides good suggestions, and feed back. Roxanne
interacts well with staff and has been consistent in her performance. Her process recordings are
thorugh and demonstrates understanding of social work practice.
**Please note: By typing my name below, I certify that I have reviewed the document,
completed my portion and agree with the content.
(Jones, Benjamin): Benjamin A.Jones Oct 30, 2015 2:39 PM
Field Instructor (agency-based supervisor)

I...

STUDENT SECTION
Agree with the evaluation.

Comments:
Thank you for the review.
**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.
(Rodriguez, Roxanne): Roxanne Rodriguez Oct 31, 2015 2:24 PM
Student

(Aloha Van Camp): Aloha VanCamp LMSW PhD Nov 14, 2015 2:03 PM
Faculty Field Liaison

Printable Version
IPT Document Management System January 1, 2014
Form: 31920