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WESTERN
WASHINGTON UN1VERS1TY

Human Services Program Form 9

LEARNING CONTRACT: Part II HSP 440: FIELD SUPERVISOR'S PERFORMANCE EVALUATION

Field Supervisor: Please complete the following evaluation and discuss it with the internship student prior to submission, The student will submit this evaluation to the University Instructor to receive course credit. Student Name: \/(A\f'~~\p. Field Supervisor: Lt:.:y Q,\\JSS Cr\texs,P-'CI.J cs (!QLO\Je,(U Agency: o.'\\v:;\ \r I)\(\.A \:\/l u .... if) '\\/ J zovz, ~ HSP440 I v HSP 440 II QuarterlYear: s"v..'(--{\\\Ic.\ Rating Scale: N/A Not Applicable or unable to assess 1 Unsatisfactory progress towards meeting performance standards 2 Satisfactorily working towards meeting performance standards Meets performance standards 3 4 Exceeds performance standards

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Performance Domains
a. Accomplishes tasks with an appropriate level of supervision b. Demonstrates appropriate levels of confidence c. Is organized and efficient in accomplishing assigned duties d. Demonstrates problem solving by obtaining necessary information and asking for help when needed e. Dresses professionally and appropriately for the work setting f. Is professional in relationships with clients and staff g. Practices confidentiality h. Shows knowledge of agency structure, function, policy, and procedures i. Punctual in reporting to work and meetings j. Accepts constructive criticism and positive feedback concerning performance k. Shows sensitivity to clients and staff while maintaining appropriate boundaries 09-10 Manual Revision

N/A

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I. Demonstrates the ability to collaborate with others m. n. o. p. q. Demonstrates awareness of and respect for diversity Demonstrates accuracy and clarity in written and verbal communication Demonstrates knowledge of accepted standards of ethical conduct Demonstrates progress on self-designed learning objectives and supportinq activities Completed all 120 hours in the practicum setting

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Please comment on progress made on Part I of the Learning Contract (learning

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Please comment on any areas identified above where the student did not meet professional performance standards.

09-10 Manual Revision

Please comment

on any areas identified

above where the student exceeded

professional performancestan:i:

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?I'b/L,;;Date I have read this evaluation and discussed it with my Field Supervisor.

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Student Signature University Instructor

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Date

Date

09-10 Manual Revision