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Bethel College Social Work - Practicum Instructor/Liaison Survey

This feedback form is one component of our evaluation of the Bethel College Field Instruction Program. The feedback from will be utilized to provide college faculty with feedback regarding their liaison activities and to give the Field Coordinator information with which to assess the success of our field placement program. Field instructors can discuss the rating with the field liaison or send the completed form to the college.
1.Field Instructor's name:(Required.)
2.Date:(Required.)
3.Name of Bethel College Faculty Liaison:
4.Field Instructor's Agency & Agency address
5.Faculty Field Liaison: How frequently has the faculty member met with you for consultation?
Please read each statement below carefully and then check which most clearly corresponds to your opinion.
6.Site visit before beginning of placement or after several weeks of field placement to assist with placement planning and completion of contract
7.Assistance with selection and planning of appropriate learning assignments for the student
8.Facilitation of conflict or problem resolution between the student, field instructor and/or agency
9.Demonstration of openness to discussing issues that may arise during the field placement
10.Demonstrated sufficient familiarity with agency policies and procedures to assist with field instruction
11.Encouragement of a collegial relationship that is open to constructive feedback.
12.Demonstrated sensitivity to issues of privacy and confidentiality
13.Provision of resources, training and/or suggestions for improving your field instruction
14.Acknowledgement and support of your field teaching responsibilities
15.Adequate clarification/orientation to the social work department: 
Satisfactory
Unsatisfactory
N/A 
Curriculum
Expectation for student's performance
Field instruction policies, forms and procedures
Educational objectives of field instruction
16.Please make any additional comments: