Field Instructor Assessment of Student Competencies
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
 -
Area Code
Phone Number
Name of your student
Your student's Program Year
*
Generalist
Specialized
BSW
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Please rate your student on their overall competence in the 9 Social Work Competencies
As you reflect on the FLEP and the student's knowledge, values, skills, cognitive and affective processes, to the best of your ability rate the student on overall attainment of competency on a scale of 1-10 (1 = not at all met, 10 indicates the student fully met expectations for that competency). The comment section is optional and can be used to clarify reasons for scores.
1. Demonstrate Ethical and Professional Behavior
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1
2
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9
10
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Competency Not Met
Competency Fully Met/Attained
1 is Competency Not Met, 10 is Competency Fully Met/Attained
Comment
2. Engage in Diversity and Difference in Practice
*
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1
2
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10
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Competency Not Met
Competency Fully Met/Attained
1 is Competency Not Met, 10 is Competency Fully Met/Attained
Comment
3. Advance Human Rights and Social, Economic, and Environmental Justice
*
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1
2
3
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9
10
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Competency Not Met
Competency Fully Met/Attained
1 is Competency Not Met, 10 is Competency Fully Met/Attained
Comment
4. Engage in Practice-Informed Research and Researched-Informed Practice
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1
2
3
4
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10
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Competency Not Met
Competency Fully Met/Attained
1 is Competency Not Met, 10 is Competency Fully Met/Attained
Comment
5. Engage in Policy Practice
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1
2
3
4
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9
10
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Competency Not Met
Competency Fully Met/Attained
1 is Competency Not Met, 10 is Competency Fully Met/Attained
Comment
6. Engage with (please rate at least two levels):
*
Rows
1
Competency not met
2
3
4
5
6
7
8
9
10: Competency Fully Met/Obtained
Individuals
1
2
3
4
5
6
7
8
9
10
Families
11
12
13
14
15
16
17
18
19
20
Groups
21
22
23
24
25
26
27
28
29
30
Organizations
31
32
33
34
35
36
37
38
39
40
Communities
41
42
43
44
45
46
47
48
49
50
Comment
7. Assess (please rate at least two levels):
*
Rows
1
Competency not met
2
3
4
5
6
7
8
9
10: Competency Fully Met/Obtained
Individuals
51
52
53
54
55
56
57
58
59
60
Families
61
62
63
64
65
66
67
68
69
70
Groups
71
72
73
74
75
76
77
78
79
80
Organizations
81
82
83
84
85
86
87
88
89
90
Communities
91
92
93
94
95
96
97
98
99
100
Comment
8. Intervene with (please rate at least two levels):
*
Rows
1
Competency not met
2
3
4
5
6
7
8
9
10: Competency Fully Met/Obtained
Individuals
101
102
103
104
105
106
107
108
109
110
Families
111
112
113
114
115
116
117
118
119
120
Groups
121
122
123
124
125
126
127
128
129
130
Organizations
131
132
133
134
135
136
137
138
139
140
Communities
141
142
143
144
145
146
147
148
149
150
Comment
9. Evaluate practice with (please rate at least two levels):
*
Rows
1
Competency not met
2
3
4
5
6
7
8
9
10: Competency Fully Met/Obtained
Individuals
151
152
153
154
155
156
157
158
159
160
Families
161
162
163
164
165
166
167
168
169
170
Groups
171
172
173
174
175
176
177
178
179
180
Organizations
181
182
183
184
185
186
187
188
189
190
Communities
191
192
193
194
195
196
197
198
199
200
Comment
Please use this space to provide any other feedback for our department
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