BallStateUniversity Department of Social Work
(765) 285-1016
VOLUNTEER / FIELDLEARNING CONTRACT AND EVALUATION
Instructions: The back of this form should be signed by the student and the site supervisor or Student Volunteer Services coordinator. A xeroxed copy of this form should be turned into the instructor initially after the goals are established, and then again at the end of the semester whenthe final evaluation is completed.
I.INTRODUCTION
Through the social work program’s required volunteer field experiences, the student has the opportunity to assume a participant-observer helper role in a human service-like or based organization. Due to the importance of this required learning experience, part of your evaluation will be based on the successful completion of this volunteer field experience. The class instructor will identify specific goals for the volunteer experience. You will also be required to identify personal learning goals for the volunteer field experience which you will list on this form.
II.VOLUNTEER / FIELD ASSIGNMENT INFORMATION
- Student: ______BSU I.D.: ______
Phone:(_____)______Email: ______
Social Work Course: SOCWK200____ SOCWK400____
B.Agency / Setting ______
Supervisor ______Address ______
Phone :(_____)______Email ______
- Student’s Personal/Professional Learning Goals:
1.
2.
3.
4.
5.
During this semester I, ______agree to participate in a volunteer field experience at the above agency / setting beginning______(date), averaging ______hours per week for a total of ______hours. I agree to complete these field experience hours by ______(date) and will be under the supervision of ______(name).
______
Student SignatureDate
- Supervisor / SVS Program Coordinator:
I have reviewed this student’s Learning Contract and Evaluation form, and understand I will be asked to complete a final evaluation on this student’s performance in the above volunteer field experience.
I have reviewed this student’s Learning Contract and Evaluation form, and understand I will be asked to complete a final evaluation.
______
Supervisor SignatureDate
- EVALUATION OF VOLUNTEER EXPERIENCE
Policies and Procedures
To protect the recipients of the volunteer service, the following policies and procedures apply to the volunteer field experience:
- Students must request and secure, or initiate a commitment to a volunteer field assignment by the end of the third full week of the semester in order to receive credit for this class assignment. If this is not done, a written explanation for not doing so must be to the instructor at the next class meeting. In such cases the instructor will determines if an alternative assignment is warranted.
- If Section I of the learning contract, for any reason, is not completed, an assignment by the field agency site or Student Voluntary Services (SVC) will not be given.
- Through assuming responsibility in the volunteer field experience, students are expected to learn about the related social service delivery system, and demonstrate basic competency in interpersonal relations and self reflection.
- Evaluation of performance at the end of the assignment will be done by the supervising person identified in Section I. The student is responsible for obtaining the completed evaluation form from his/her supervisor, and returning the form to the instructor. The final evaluation form becomes part of the application materials submitted for formal admission to the major, and as such becomes part of the student’s academic file located in the social work department’s office. The student has access to her/his file.
- Assignments, as specified in the course syllabus, must be completed and submitted to the instructor.
- Any student found falsifying the documentation of volunteer field hours, log entries, orthe final evaluation form will receive an automatic “F” for the Volunteer Field Experience assignment for the class.
- Students are expected to abide by the policies and expectations of the volunteer field agency site in regards to attendance, punctuality, dress, paperwork, ethical standards (e.g. confidentiality), and the carrying out volunteer responsibilities. Students who violate site policies may not be permitted to continue in the volunteer field experience and this will be reflected in their final grade for the Volunteer Field Experience assignment.
1
Final Volunteer Field Experience Evaluation Form
Supervisor Instructions:
Please check any of the following to describe the basis for evaluating the student’s performance.
Check all that apply.
_____ 1.Direct Observation
_____ 2.Co-Worker Feedback
_____ 3.Client Feedback
_____ 4.Performance in Training Sessions
_____ 5.Other (please specify) ______
How well did the student perform in the following areas? Please circle the number which best
describes your assessment of how well the student performed in each area described. The
“For Office Use Only” column translates ratings into practice competency assessment data.
N/A / 1 / 2 / 3 / 4 / 5NOT
APPLICABLE
There has not yet been the opportunity to develop and practice this skill. / NEVER MEETS EXPECTATIONS
The student consistently performs below a level that would be expected for a bachelor-level social worker. Shows little to no evidence of understanding the concept and/or ability to effectively apply the skill. / RARELY MEETS
EXPECTATIONS
The student frequently performs at a level below what would be expected for a bachelor-level social worker. / MEETS
EXPECTATIONS
The student reliably performs at a level that would be expected for a bachelor-level social worker. / OFTENEXCEEDS
EXPECTATIONS
The student frequently performs at a level above what would be expected for a bachelor-level social worker. / ALWAYSEXCEEDS
EXPECTATIONS
The student consistently performs at a level above what would be expected for a bachelor-level social worker.
- Demonstrated an understanding of the overall agency purpose andorganizational
structure.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
B.Functioned well within thestructure of the volunteer field agency setting.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
C.Set appropriate learning goals and actively sought to accomplish these goals.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
3
D.Familiarized her/himself with the volunteer field agency’s policies and goals and
worked effectively with these policies and goals.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
E.Conducted him/herself professionally when at the volunteer field agency site.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
F.Attended regularly and on time, or informed the volunteer field agency setting
ahead of time of absences.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
G.Dressed appropriately for the volunteer field agency setting.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
H.Sustained effort with assignments/clients and followed through on
responsibilities.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
I.Demonstrated an understanding of the student volunteer’s role in providing
services, and successfully assumed this role.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
J.Maintained appropriate boundaries in relationships and other behaviors.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
K.Related in asensitive, genuine, and respectful manner to clients and staff.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
L.Communicated effectively verbally and nonverbally.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
M.Demonstrated the ability to listen effectively.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
N.Demonstrated empathy when providing services.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
O.Maintained confidentiality in performing volunteer/field responsibilities.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
Q.Developed positive relationships with clients and staff from backgrounds
dissimilar from their own.(age, class, color, disability, ethnicity, family structure,
gender, gender identity, marital status, national origin, race, religion, sex, and sexual orientation)
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
- Demonstrated an awareness of the economic, social, and political factors that
adversely affect clients being served by the volunteer field agency.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
- Advocated appropriately for the clients being served by the agency.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
T.Sought supervision and constructive feedback regarding her/his performance.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
U.Demonstrated the ability to learn through observation.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
V.Demonstrated self-confidence in performing volunteer responsibilities.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
W.Demonstrated Initiative in performing volunteer/field responsibilities appropriate
assertiveness skills.
NOT NEVERMEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
------
X.Did the student fulfill their time and professional commitment to the field agency site?
1._____Yes2._____No
If no, please explain:
Y.According to your records, how many hours did the student volunteer at your field agency? ______
- How many absences occurred, which the student did not make up?______
Would you be willing to work with this student again? Please explain.
SUPERVISOR’S OVERALL EVALUATION
I rate this student’s overall performance in this volunteer field experience as:
NOT NEVER MEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
Please elaborate on this student’s strengths and weaknesses:
______
Supervisor SignatureDate
STUDENT’S OVERALL SELF EVALUATION 1.2
I rate my overall performance in this volunteer experience as:
NOT NEVER MEETS RARELY MEETS MEETS OFTEN EXCEEDS ALWAYS EXCEEDS
APPLICABLE EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATIONS
N/A ------1 ------2 ------3 ------4 ------5
Please elaborate:
______
Student SignatureDate
Revised 8/30/12
1