Field Experience Evaluation Form

FIELD EXPERIENCE EVALUATION
To be filled out by Site Supervisor with the Student
Upon Completion of Work Hours: ____135/150 hours (3 hours credit)

Field Experience Student __________________________________________________________________

Site ________________________________________ Site Supervisor _____________________________

Space has been left for comments on each item. Use additional sheets if needed.

Check the appropriate column. Rating scale: 4 -- Outstanding; 3 -- Good (better than average): 2 -- Satisfactory (average); 0 --Unacceptable; NA--Not Applicable.

PART I: Site Objectives

4

3

2

1

0

NA

How well did the FE student work toward and meet the original objectives as established on the Field Experience Agreement? Objective #1 (specify).

Objective #2

Objective # 3

Objective # 4

PART II: Site Experiences

Became informed about existing institutional policies in order to interpret then for effective use of services and programs.

Contributed to the maintenance of an atmosphere conducive to achieving the goals and objectives of the organization.

Became aware of the various reports developed each year (e.g. annual reports and budgets), including how information is gathered, processed, routed and the use to which reports are put.

Discussed with the supervising professional the criteria used to evaluate services and/or programs.

Participated in agency activities in the community, as appropriate.

Contributed unique talent to special projects.

PART III: Professional Competencies

Research and information seeking skills (knowledge of information sources; ability to determine what the user really wants; use of methods of research).

Organizational ability (ability to organize and follow through on assigned tasks; planning ability; organization of work).

Effectiveness of oral and written expression (ability to speak and write effectively).

Skill in presentation, teaching or user guidance (ability to teach use of agency materials; ability to stimulate the interest of users).

Knowledge of special equipment (skill in the operation of audio/visual equipment, ability to adapt to the computer on site).

Interpersonal relationships (ability to work cooperatively with the other staff and with the user population).

PART IV: Personal Qualities

Work habits (alertness, thoroughness, dependability, accuracy, punctuality).

Initiative (creativity, resourcefulness, leadership).

Responsibility (application to work, conscientious, willingness to serve).

Adaptability (ability to withstand interruptions, flexibility).

Courtesy (rapport with others, sensitivity, responsiveness to users' needs).

Ability to accept criticism (reacts well to suggestions, willingness to learn).

Judgment (tact, appropriate assertiveness, maturity, self-control).

Integrity (ethical standards).

PART V: Overall Evaluation and Comments

Please review your ratings of the student and assign an overall evaluation: (circle one)

4
Outstanding 3
Good 2
Satisfactory 1
Needs Improvement 0
Unacceptable

Comments: ____________________________________________________________________________

____________________________________________________________________________________

If an appropriate position were available, I would seriously consider this student as a candidate.
_________ Yes _______ No

Signature ___________________________________________
(Site Supervisor)

I have seen and discussed this evaluation with my Site Supervisor.
Comments:

____________________________________________________________________________________

Signature ___________________________________________
(Student)

I have seen this evaluation and reviewed the Field Experience paper assigned by me. The student has completed these portions of the Field Experience Requirements.

Recommended Grade: P L F

Signature ___________________________________________
(Faculty Supervisor)

When all signatures have been obtained, submit completed evaluation to the Field Experience Coordinator's mailbox.

PART I: Site Objectives	4	3	2	1	0	NA
How well did the FE student work toward and meet the original objectives as established on the Field Experience Agreement? Objective #1 (specify).
Objective #2
Objective # 3
Objective # 4
PART II: Site Experiences
Became informed about existing institutional policies in order to interpret then for effective use of services and programs.
Contributed to the maintenance of an atmosphere conducive to achieving the goals and objectives of the organization.
Became aware of the various reports developed each year (e.g. annual reports and budgets), including how information is gathered, processed, routed and the use to which reports are put.
Discussed with the supervising professional the criteria used to evaluate services and/or programs.
Participated in agency activities in the community, as appropriate.
Contributed unique talent to special projects.
PART III: Professional Competencies
Research and information seeking skills (knowledge of information sources; ability to determine what the user really wants; use of methods of research).
Organizational ability (ability to organize and follow through on assigned tasks; planning ability; organization of work).
Effectiveness of oral and written expression (ability to speak and write effectively).
Skill in presentation, teaching or user guidance (ability to teach use of agency materials; ability to stimulate the interest of users).
Knowledge of special equipment (skill in the operation of audio/visual equipment, ability to adapt to the computer on site).
Interpersonal relationships (ability to work cooperatively with the other staff and with the user population).
PART IV: Personal Qualities
Work habits (alertness, thoroughness, dependability, accuracy, punctuality).
Initiative (creativity, resourcefulness, leadership).
Responsibility (application to work, conscientious, willingness to serve).
Adaptability (ability to withstand interruptions, flexibility).
Courtesy (rapport with others, sensitivity, responsiveness to users' needs).
Ability to accept criticism (reacts well to suggestions, willingness to learn).
Judgment (tact, appropriate assertiveness, maturity, self-control).
Integrity (ethical standards).