The University of North Carolina at Pembroke

Department of Social Work

Midterm Evaluation

BSW {
Name

MSW Foundation

orrntern Col\,[q,n

Instructions

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for Rating fnturns on the I0

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MSW Foundation

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Date l0-tl-15

Competencies in the First Part of the Evaluation:

The standard by which an intern is to be compared is that of a foundation level social worker. The l0
competencies that are specified in this evaluation form are those established by our national accrediting
organization (the Council on Social Work Education). Under each competency statement are several
items that we ask you to rate according to the following criteria.
5

4
a

2
I

The intern has excelled in this area

The intern is functioning above expectations for interns in this area
The intern has met the expectations for interns in this area
The intern has not as yet met the expectations in this area, but there is hope that the intern will meet
the expectations in the near future
The intern has not met the expectations in this area, and there is not much hope that the intern will
meet the expectations in this area in the near future

if desired. Please be sure to indicate those

in which you think the intern is particularly strong and those areas that need improvement.

Comments may be made under any competency statement,

areas

Comments may be made under any competency statement. Please be sure to indicate those areas in which
you think the intern is particularly strong and those areas that need improvement. Please give examples
for any area in which the student received a rating of I or 2.

Evaluation should be a shared process with an opportunity for the student and agency field instructor to
discuss similarities and differences in perception. Although the agency field instructor is responsible for
completing the evaluation, it is the responsibility of the faculty field director to assign a grade. The
student's overall grade for the course will be determined by the faculty field director and based on the

overall evaluation of the student's performance in placement in conjunction with the agency field
instructor's evaluation, classroom participation, and course assignments.
This evaluation is intended to give the intern feedback about her or his performance.
NOTE: If you prefer to use another evaluation system in addition to this form to evaluate a student's
performance,
discuss this with the facultv field director.
Competence

#1:

Intern identifies as a professional social worker and conducts himself/herself

accordinplv.

l.l
1.2
1.3

1.4
1.5

1.6

Advocates well for client access to the services of social work

Practices personal reflection and self-correction to assure continual
professional development
Attends wellto professional roles and boundaries
Demonstrates professional demeanor n appearance
Demonstrates professional demeanor n communlcatlon
Uses supervision and consultation effectively
Comments:

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2
2

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4
4

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4
4
4

4)

5
5
5

Competence

#2:

Intern applies social work ethical principles to guide his or her professional
ractice.

2.1

2.2
2.5
2.4

Recognizes and manages personal values in a way that allows

Professional values to guide practice (e.g., on such issues as

Abortion and gay rishts)

Is knowledgeable of, and abides by, the ethical standards of
the profession
Tolerates well ambiguiw in resolvine ethical conflicts
Is able to apply strategies of ethical reasoning to arrive at principled
decisions

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a

4
4

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Comments:

Competence

#3: Intern applies critical thinking to inform and communicate

professional

nts.
3.1

3.2
3.3

Is skilled at appraising and integrating multiple sources of

knowledge; including research-based knowledge and practice

wisdom
Is skilled atanalyzingmodels of assessment, prevention,
intervention. and evaluation
Demonstrates effective oral and written communication in working
with individuals, families, groups, organizations, communities, and

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colleagues

Comments: { I

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4.1

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Recognizes the extent to which a culture's structures and values

may oppress, marginalize, alienate, or create or enhance privilege

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and power

4.2
4.3

4.4

Has sufficient self-awareness to eliminate the influence of personal

biases and values in working with diverse qrouDs
Recognizes and communicates her or his understanding of the
importance of difference in shapine life experiences
Views herself or himself as a learner and engages those he or she

works (clients) with as informants

Comments:

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#5:

Competence

Intern advances human rishts and social and economic iustice.

5.1

Understands the forms and mechanisms of oppression and

5.2

discrimination
Is skilled at advocating for human rights and social and economic

5.3

Is skilled at engaging in practices that advance social and economlc

iustice

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3
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iustice
Comments:

Competence
research.
6.1

6.2

#6:

Intern engages in research-informed practice and

Is skilled at using practice experience to inform research

Is skilled at using research findings to improve practice, policy, and
social service deliverv

H
U

practice-informed

J
a

4
4

5
5

Comments:

Competence
7.1

7.2

#7:

Intern applies knowledge of human behavior and the social environment.

Is skilled at utilizing conceptual frameworks (Theories) to guide the

Drocesses of assessment. intervention- and evaluation
Is knowledgeable about the range of social systems in which people
live and can apply it to understand client behaviors and

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environments.
Comments:

Competence

#8:

Intern engages in policy practice to advance social and economic well-being and
to deliver effective social work services.

Is skilled at analyzing, formulating, and advocating for policies that

advance social well-bei
Is skilled at collaborating with colleagues and clients for effective

Comments:

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#92

Intern

to contexts that

Is skilled at continuously discovering, appraising, and attending to

changing locales, populations, scientific and technological
developments, and emerging societal trends in order to provide
relevant services
Is skilled at providing leadership in promoting sustainable changes
in service delivery and practice to improve the quality of social
services

Comments:

Competence

0.l

t0.2
10.3
10.4

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0.6

10.7
10.8
10.9

0.10
0.1 I

0.12
10.13

#10: Intern

engages, assesses, intervenes and evaluates

tions. and communities.

Is skilled at preparing for action with individuals, families, groups,

organizations, and communities.
Is skilled at using empathy and other intemersonal skills.
Is skilled at developing a mutually agreed-on focus of work
Is skilled at collecting, organizins, and intemretine client data.
Is skilled at assessing client strengths and limitations.
Is skilled at developing mutually agreed-on intervention goals and
objectives.
Is skilled at selecting appropriate intervention stratesies.
Is skilled at initiating actions to achieve organizational soals.
Is skilled at implementing prevention interventions that enhance
client capacities.
Is skilled at helping clients resolve problems.
Is sk led at negotiating, mediating, and advocatins for clients
Is sk led at facilitating transitions and endinss.
Is skilled at analyzing, monitoring, and evaluating interventions

criticallv.
Comments:

with individuals, families,

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4
4

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4

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4
4
4

5
5
5

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a
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J
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4
4
4
4

5
5

5
5

Overall Evaluation at MIDTERM:

Please check one of the followine at the midterm eva luation
The ntern has excelled

,/

The ntern is functionine above expectations

The ntern has met exDectations
The intern has not as yet met expectations, but there is hope that the intern
the near future

will meet expectations in

The intern has not met the expectations and there is not much hope that the intern will meet
expectations in the near future

Number of Clock Hours Completed

Comments/elaboration

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Signature of Agency Field Instructor

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Agency

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Thefollowing section should be completed by the intern:

My agency supervisor and faculty supervisor have discussed this evaluation with me, and I have received
copy. My agreement or disagreement follows:

I agree with the evaluation

I do not agree with evaluation

Intern's Signature C

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If the intern

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disagrees with the evaluation she/he should state that disagreement in writing and
submit a copy to both the agency field instructor and the faculty field director. A meeting
between the student, agency instructor, and faculty field director should then be held to discuss
the disagreement.