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Pg. 1 SAMPLE MSW FOUNDATION LEARNING …

Pg. 1 1=Unacceptable Progress 2=Insufficient Progress 3=Emerging Competence 4=Competent 5=Advanced Competence N/A=Not applicable (please explain) SAMPLE MSW FOUNDATION LEARNING contract /EVALUATION WESTERN MICHIGAN UNIVERISTY SCHOOL OF SOCIAL WORK Field Education LEARNING contract and Evaluation Check Appropriate: ___ BSW X MSW FOUNDATION ___ MSW Interpersonal Practice (IP) Concentration ___ MSW Policy, Planning & Administration (PP&A) Concentration Student s Name: Joe Friday Phone 269-555-1212 E-mail: Primary Field Instructor: Angelica Domain Agency: Flout County CMH Address: 1234 Main St. Flout, MI 49000 Phone 269-555- 1313 E-mail: Secondary Field Instructor: _____ Phone _____E-mail:_____ faculty Liaison: Lou Ignace Phone 269-555-1414 E-mail: INSTRUCTIONS: 1. The student completes the top of this document. 2. The student and the field instructor then agree on one or more agency or placement specific activities or products the student will complete that will demonstrate their competency for each practice behavior and enter these into the space provided.

3. The student and the field instructor then print this document and sign and date in the space designated as “Learning Contract” on the final page of this document. 4. The student submits this to the Faculty Liaison for review, approval and signature/date if no changes are needed. 5.

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