The University of North Carolina at Pembroke

Department of Social Work

Midterm Evaluation

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Name

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fnstructionsfor Rating Interns on the 10 Competencies in the First Part of the Evaluation:
The standard by which an intern is to be compared is that of a foundation level social worker. The 10
competencies that are specified in this evaluation form are those established by our national accrediting
organization (the Council on Social Work Education). Under each competency statement are several
items that we ask you to rate according to the following criteria.
5

4
3

2
1

The intern has excelled in this area

The ir(ern is functioning above expectations for intems in this area
The intern has met the expectations for interns in this area
The intern has not as yet met the expectations in this area, but there is hope that the intern will meet
the expectations in the near future
The intern has not met the expectations in this area, and there is not much hope that the intern will
meet the expectations in this area in the near future

Comments may be made under any competency statement, if desired. Please be sure to indicate those
areas in which you think the intern is particularly strong and those areas that need improvement.
Comments may be made under any competency statement. Please be sure to indicate those areas in which
you think the intern is particularly strong and those areas that need improvement. Please give examples
for any area in which the student received a rating of 1 or 2.
Evaluation should be a shared process with an opporhrnity for the student and agency field instructor to
discuss similarities and differences in perception. Although the agency field instructor is responsible for
completing the evaluation, it is the responsibility of the faculty field director to assign a grade. The
student's overall grade for the course will be determined by the faculty field director and based on the
overall evaluation of the student's performance in placement in conjunction with the agency field
instructor's evaluation, classroom participation, and course assignments.
This evaluation is intended to give the intern feedback about her or his performance.
NOTE: lf you prefer to use another evaluation system in addition to this form to evaluate a student's
performance, please discuss this with the faculty field director.
Competence

#1:

Intern identifies as a professional social worker and conducts himself/herself

accordrnqly.

1.1

1.2
1.3

1.4
1.5

t.6

Advocates well for client access to the services of social work

Practices personal reflection and self-correction to assure continual
orofessional development
Attends wellto professional roles and boundaries
Demonstrates professional demeanor in apDearance
Demonstrates professional demeanor in communication
Uses supervision and consultation effectively
Comments:

2
2

2
2
2

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1

4
4

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4
4
4
4

Competence

#2:

Intern applies social work ethical principles to guide his or her professional

2.1

Recognizes and manages personal values in a way that allows

Professional values to guide practice (e.g., on such issues as
Abortion and gay rishts)

2.2

Is knowledgeable of, and abides by, the ethical standards

2.4

of

the profession
Tolerates well ambizuiW in resolvine ethical conflicts
Is able to apply strategies of ethical reasoning to arrive at principled
decisions

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2
2

4
4

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Comments:

Competence

3.1

3.2

5.J

#3: Intern applies critical thinking to inform and communicate

Is skilled at appraising and integrating multiple sources of

knowledge; including research-based knowledge and practice
wisdom
Is skilled atanalyzingmodels of assessment, prevention,
intervention, and evaluation
Demonstrates effective oral and written communication in working
with individuals, families, groups, organizations, communities, and

professional

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colleagues
Comments:

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Intern

diversitv and difference in

4.t

Recognizes the extent to which a culture's structures and values

may oppress, marginalize, alienate, or create or enhance privilege

4.2

Has sufficient self-awareness to eliminate the influence of personal

biases and values in working with diverse groups
Recognizes and communicates her or his understanding of the
importance of difference in shaping life experiences
Views herself or himself as a learner and engages those he or she

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and power

4.3

4.4

works (clients) with as informants

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Comments:

Comnetence

#5:

Intern advances human riehts and social and economic iustice.

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5.1

Understands the forms and mechanisms of oppression and

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5.2

discrimination
Is skilled at advocating for human rights and social and economic

5.3

iustice
Is skilled at engaging in practices that advance social and economic
iustice

Comments:

Competence
research.
6.1

6.2

#6:

Intern engagm in research-informed practice and

Is skilled at using practice experience to inform research

Is skilled at using research findings to improve practice, policy, and
social service delivery

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2
2

practice-informed

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Comments:

Comnetence

#7:

Intern

of human behavior and the social environment.

7.1

Is skilled at utilizing conceptual frameworks (Theories) to guide the

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7.2

processes of a.ssessment, intervention, and evaluation

Is knowledgeable about the range of social systems in which people
live and can apply it to understand client behaviors and

a_)

environments.
Comments:

Competence

8.1

8.2

#8:

Intern engages in policy practice to advance social and economic well-being and
to deliver effective social work services.

Is skilled at analyzing, formulating, and advocating for policies that

advance social well-being
Is skilled at collaborating with colleagues and clients for effective
policy action
Comments:

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Intern

to contexts that

Is skilled at continuously discovering, appraising, and affending to

changing locales, populations, scientific and technological
developments, and emerging societal trends in order to provide
relevant services
Is skilled at providing leadership in promoting sustainable changes
in service delivery and practice to improve the quality of social

9.2

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services
Comments:

Competence

10.1

10.2
10.3

r0.4
I0.5
10.6

ta.7
10.8
10.9
10.10

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10.t2
10.13

#10: Intern

engages, assesses, interenes and evaluates

groups, organizations, and communities.

Is skilled at preparing for action with individuals, families, groups,

organizations, and communities.
Is ski led at using empathy and other interpersonal skills.
Is ski led at developins a mutuallv agreed-on focus of work
Is sk led at collecting, organizins. and intemreting client data.
Is ski led at assessing client strengths and limitations
Is skilled at developing mutually agreed-on intervention goals and
obiectives.
Is skilled at selecting appropriate intervention strategies.
Is skilled at initiatine actions to achieve orsanizational goals.
Is skilled at irnplementing prevention interventions that enhance
client capacities.
Is skilled at helpins clients resolve problems.

Is skilled at neeotiatine. mediatins. and advocatine for clients.

Is skilled at facilitating transitions and endings.
Is skilled at analyzing, monitoring, and evaluating interventions

critically.

with individuals, families,

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5
5

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5
5

Comments:

Overall Evaluation at
Please check one of the follow
The intern has excelled

at the midterm evaluation.

The intern is functionins above expectations

The intern has met expectations
The intern has not as yet met expectations, but there is hope that the intern will meet expectations in
the near future
The intem has not met the expectations and there is not much hope that the intern will meet
expectations in the near future

Number of Clock Hours Completed.

Comments/elaboration:

Signature

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Asencv Field lnstruct

Agency

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Thefollowing section should be completed by the intern:

My agency supervisor and faculty supervisor have discussed this evaluation with me, and I have received
a copy. My agreement or disagreement follows:
I agree with the evaluation
I do not aeree with evaluation

Intern's Signature

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If the intern disagrees with the evaluation shelhe should state that disagreement in writing and
submit a copy to both the agency field instructor and the faculty field director. A meeting
between the student, agency instructor, and faculty field director should then be held to discuss
the disagreement.