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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.

1=Unacceptable Progress 2=Insufficient Progress 3=Emerging Competence 4=Competent 5=Advanced Competence N/A=Not applicable (please explain) ... I will bring my learning contract for review once a month during supervision. ... rights are distributed equitably and without prejudice. Practice Behaviors Activities or products: ...

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