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Bethel College - SWK Field Instructor/Liaison Program 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.

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* 1. Field Instructor's name:

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* 2. Date:

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* 3. Name of Bethel College Faculty Liaison:

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* 4. Field Instructor's Agency & Agency address

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* 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.

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* 6. Site visit before beginning of placement or after several weeks of field placement to assist with placement planning and completion of contract

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 7. Assistance with selection and planning of appropriate learning assignments for the student

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 8. Facilitation of conflict or problem resolution between the student, field instructor and/or agency

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 9. Demonstration of openness to discussing issues that may arise during the field placement

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 10. Demonstrated sufficient familiarity with agency policies and procedures to assist with field instruction

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 11. Encouragement of a collegial relationship that is open to constructive feedback.

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 12. Demonstrated sensitivity to issues of privacy and confidentiality

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 13. Provision of resources, training and/or suggestions for improving your field instruction

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 14. Acknowledgement and support of your field teaching responsibilities

Satisfactory

Unsatisfactory

N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 15. Adequate clarification/orientation to the social work department:

	Satisfactory	Unsatisfactory	N/A
Curriculum	Curriculum Satisfactory	Curriculum Unsatisfactory	Curriculum N/A
Expectation for student's performance	Expectation for student's performance Satisfactory	Expectation for student's performance Unsatisfactory	Expectation for student's performance N/A
Field instruction policies, forms and procedures	Field instruction policies, forms and procedures Satisfactory	Field instruction policies, forms and procedures Unsatisfactory	Field instruction policies, forms and procedures N/A
Educational objectives of field instruction	Educational objectives of field instruction Satisfactory	Educational objectives of field instruction Unsatisfactory	Educational objectives of field instruction N/A

Please give a brief explanation for Unsatisfactory or N/A response and any additional comments:

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* 16. Please make any additional comments: