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SCHOOL OF SOCIAL WORK
PRACTICUM
LEARNING CONTRACT/GRADE EVALUATION FORM
Student Name
Semester(s) taking:
Practicum Instructor(s)
( ) Fall 20
Practicum Agency
( ) Spr 20
( ) Sum 20
BSW
MSW Foundation
MSW Advanced
Concentration
Weekly Practicum Work Schedule:
Mon.
Tues .
Wed .
Thur .
Fri .
Other
The Learning Activities and Objectives may be amended or renegotiated at any time if both the practicum instructor and
student agree and the changes meet Practicum Guidelines. A letter must be sent to the Practicum Coordinator as soon as
changes are considered and the rationale for the changes must be included. The letter should be signed by both
practicum instructor and student.
**Goals, Learning Activities, Objectives**
The first five goals represents a core Social Work Competency. The goals are as follows: Knowledge, Skills,
Professional Development, Diversity, and Integration of Theory, Research & Practice. Each student is to have at least
one primary assignment [learning activity] with a Social Work Competency goal. Space is also provided for other
assignments. Be very specific when listing outcome objectives!
Knowledge Goal(s): [Will be aware & understand dynamics of agency, needs of clients, role of social workers & other agency professionals.]
Knowledge Outcome Objectives : [Demonstrate understanding of social work theories, concepts, ethics & values. Advanced level students
should be also have specialized knowledge from required concentration courses that have specific application to the advanced practice required in
the concentration field setting. Be specific.]
Knowledge Learning Activity(ies):
Comments regarding Knowledge after 256 hours in practicum.
2
Comments regarding Knowledge after 512 hours in practicum .
Skills Goal: [Identify skill areas and learn new practice skills in social work specific to practicum agency .]
Skills Outcome Objectives : [Demonstrate skills in working with clients, working within the structure of the agency, and in the use of oral and
written professional communications. Be specific.]
Skills Learning Activities
Comments regarding Skills after 256 hours in practicum.
Comments regarding Skills after 512 hours in practicum .
Professional Development Goal(s) [Understand the professional approach to social problems/issues that agency is dealing with and
behave & perform as a professional social worker.
Professional Dev. Outcome Objectives : [Awareness, appreciation of, and achievement of skill in professional relationships with all
persons who are concerned with the clientt's welfare and acceptance, and use of professional supervision. Also, demonstrated use and applicaiton of
values and ethics of the profession.]
Professional Dev. Learning Activity(ies):
Comments regarding Professional Development after 256 hours in practicum.
3
Comments regarding Professional Development after 512 hours in practicum .
Diversity Goal: [Awareness of self in relation to, and experience in, working with persons of other racial, ethnic and social status groups.]
Diversity Outcome Objectives: [Demonstration of, and experience in, working with persons different from their own racial, ethnic, and
social status groups. Be specific.]
Diversity Learning Activity(ies):
Comments regarding Diversity after 256 hours in practicum.
Comments regarding Diversity after 512 hours in practicum .
Integration of Theory, Research & Practice Goal: [Awareness, appreciation, and demonstration of skill in evaluation, research and
other areas of administration.]
Integration of Theory, Research & Practice Outcome Objectives: [Demonstration of skill and ability to apply research findings to
practice settings. Demonstration of skill and ability in evaluation, and other areas of administration.. Be specific.]
Integration of Theory, Research & Practice Learning Activity(is):
Comments regarding Integration of Theory, Research & Practice after 256 hours in practicum.
4
Comments regarding Integration of Theory, Research & Practice after 512 hours in practicum .
Other Assignments
Goal:
Outcome Objectives:
Learning Activity(is) :
Comments after 256 hrs .
Comments after 512 hrs.
Goal :
Learning Activity(is):
Outcome Objectives :
Comments after 256 hrs .
Comments after 512 hrs.
[You may add other Goals, Objectives, and Learning Activities . Copy this page or make your own following the
same format.]
UNO SCHOOL OF SOCIAL WORK
PRACTICUM GRADE EVALUATION FORM
Practicum Beginning Date: ______________ Practicum Projected Ending Date: _____________
_____ BSW
_____ MSW Foundation
_____ MSW Advanced
Print and Sign (Signatures indicate agreement to stated learning activities, goals and objectives):
Student (print): ___________________________________________
Student Signature: ________________________________________ Date: ________________________
LCSW Supervisor (print): __________________________________
LCSW Supervisor Signature: ________________________________ Date: ________________________
Task Supervisor (print): ____________________________________
Task Supervisor Signature: __________________________________ Date: ________________________
Faculty Liaison Signature: __________________________________ Date: ________________________
LEVELS OF PERFORMANCE & GRADING SCALE
*Exceptional (A+): Consistently performs well beyond expectations in all areas of practicum.
*Excellent (A, A-): Displays mastery of the essential and related concepts, goes beyond the requirements.
*Very Good (B+): Consistently performs above acceptable level of criteria, displaying care and thought.
*Acceptable (B): Usually enthusiastic about assignments, meets performance criteria most of the time.
*Unacceptable (B-, C, D, F): Demonstrates minimal knowledge of related concepts learned in class.
Grades:
Level of Performance Letter Grade for 256 hours . (send copy) ______________________________________
Any Additional Comments: __________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Student Signature: __________________________________________ Date: ________________________
LCSW Supervisor Signature: _________________________________ Date: ________________________
Task Supervisor Signature: ___________________________________ Date: ________________________
Level of Performance Letter Grade for 512 hours . (send original) ____________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Student Signature: __________________________________________ Date: ________________________
LCSW Supervisor Signature: _________________________________ Date: ________________________
Task Supervisor Signature: ___________________________________ Date: ________________________
[UNO School of Social Work Practicum Office, 6001 Dodge Street, Annex 40, Omaha, NE 68182]
[Claudette Lee, Practicum Coordinator, UNO School of Social Work, 6001 Dodge, Omaha, NE 68182 ]
SCHOOL OF SOCIAL WORK
PRACTICUM
LEARNING CONTRACT, IN-PROGRESS EVALUATION, GRADE EVALUATION
INSTRUCTIONS
General Instructions
The Learning Contract [goals, learning activities, objectives] should be completed during the first two weeks of
practicum. It is to be completed by the student and reviewed by the practicum instructor(s) or both may work together to
complete this. It is to be signed by both before a copy is sent to the Practicum Office. Students should use the agency
description of their practicum experience as a guide when completing the Learning Contract and attach a copy to the
contract. Practicum Instructor, and student should retain individual copies. See your Practicum Calendar for the date
this is due. A copy of the Learning Contract Agreement (with signatures) should also be sent at this time.
Please Note: Each goal represents a core Social Work Competency. The goals are as follows: Knowledge, Skills,
Professional Development, Diversity, and Integration of Theory, Research & Practice. There is to be one primary
assignment in each area.
In-Progress Evaluation
This is not to determine a grade, but to see if the student is on task and progressing appropriately with her/his
assignments. It is also a time to note concerns and/or problematic issues which have been noticed and should be
discussed with the student and Faculty Liaison.
256 Hour and 512 Hour Evaluations
A copy of the 256 hour evaluation is to be sent to the Practicum Office when those hours are
completed and the original sent when the practicum is completed [512 hours]. Performance expectations for the
generalist practicum [BSW and Foundation Graduate] and the advanced practicum differ. Expectations may be found in
the Practicum Manual under educational objectives of the practicum and in the appropriate Practicum Syllabi under
objectives. However a summary of the expectations and a glossary of terms follows:
BSW and Foundation Graduate [Generalist Practicum]
*Knowledge: Awareness of, appreciation for, and demonstration of the understanding of basic social work
theories, concepts, ethics and values.
*Skills:
Beginning skills in the use of social work practice principles. Demonstration of minimal to
moderate skill in working with clients, working within the structure of the agency, and in the use of oral
and written professional communications.
*Professional Development: Awareness, appreciation of, and achievement of minimal to moderate skill in
professional relationships with all persons, according to their frame of reference, who are concerned
with the client's welfare. Acceptance and use of professional supervision to enhance learning.
Demonstrated use and application of values and ethics of the profession.
*Diversity:
Awareness of self in relation to, and experience in working with, persons of other racial, ethnic
and social status groups.
*Integration of Theory, Research and Practice
Awareness, appreciation, and demonstration of beginning to moderate skill in evaluation, research, and
other areas of administration. Beginning to moderate skills in applying theories and concepts in assessing
and intervening in client problems.
Advanced Graduate [Advanced Practicum]
*Knowledge: Demonstration of substantial knowledge of social work theories and concepts, ethics and values.
Substantial specialized knowledge from required concentration courses that have specific
application to the advanced practice required in the concentration field setting.
*Skills:
Demonstration of moderate to substantial skills in working with clients, working within in the
structure of the agency, and in the use of oral and written professional communications. There should be
evidence of critical thinking skills which allow for the appropriate level of interventions. Demonstration
of substantial specialized skills from required concentration courses that have specific application to the
advanced practice required in the concentration field setting.
*Professional Development: Demonstration of moderate to substantial expertise in developing and
maintaining professional relationships with all persons, according to their frame of reference, who are
concerned with the client's welfare. Ability to use supervision and consultation to promote both
effective practice and ongoing professional development.
*Diversity:
Demonstration of, and experience in, working with persons different from their own racial, ethnic
and social status groups.
*Integration of Theory, Research and Practice
Demonstration of skill and ability to apply research findings to practice settings and to conduct
empirical research on one's own practice within the selected concentration. Skill and ability in
evaluation, and other areas of administration.
The following glossary of terms defines various levels of knowledge, attitudes and skills:
Related to Knowledge:
<
Awareness: Cognizance of major considerations in subject area. [BSW]
<
Familiarity: A detailed knowledge of subject area. [BSW, MSW]
<
Understanding: Detailed knowledge of subject area and ability to see interrelationships within and between
subject matter and other bodies of knowledge. [MSW]
Related to Attitude:
<
Appreciation: Aware that the subject area is of some importance, does not influence behavior. [BSW]
<
Acceptance: Has the conviction that this is true. Influences behavior for quality. [BSW, MSW]
<
Commitment: High degree of certainty. Influences behavior consistently. [MSW]
Related to Skill:
<
Minimal: Ability to responsibly see, hear and recognize. Ability to perform part of a task by working with
others, but not to carry the task out by oneself. [BSW]
<
Moderate: Ability to perform or carry out responsibility by oneself. [BSW, MSW]
<
Substantial: Ability to perform and carry out responsibility utilizing a variety of approaches. [MSW]
[Should any "problem" situations arise, please contact your Faculty Liaison as quickly as possible. ]
Practicum Office, UNO School of Social Work, 6001 Dodge, Omaha, NE 68182
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