MASTER OF SOCIAL WORK PROGRAM
MSW FACULTY FIELD LIAISON VISIT GUIDE

MSW Student		
Date of MSW Field Site Visit		
MSW Field Agency		
MSW Field Instructor		
MSW Task Supervisor 
(If applicable)		
Assigned MSW Faculty Field Liaison		
Field Course Number	SOWK 6055  SOWK 6056 SOWK 6057 SOWK 7055  SOWK 7056 SOWK 7057	

Individuals Present During Site Visit (Circle)	MSW Field Instructor	MSW Task Supervisor	MSW Field Student	Other:	

Total Hours Completed (225 required)		
Total Supervision Hours (16 required)		
Document plan to address any deficiencies in agency hours or supervision hours.

	

Target Population of the Agency (Circle)	Children	Adults	
	Adolescents	Elderly	

Methods of Social Work Utilized in Agency (Circle)	Case Management	Individual/Family Counseling	Intervention	
	Information/Referral	Group Counseling	Macro Activities	
	Assessment 	Crisis Intervention	Other: 	

Student Identified Strengths

FI/TS Identified Strengths

		

Student Identified Areas of Growth

FI/TS Identified Areas of Growth

		

REVIEW OF LEARNING CONTRACT
Ethical & Professional Behavior		
Diversity & Difference in Practice		
Advance Human Rights & Social, Economic, &Environmental Justice		
Engage in Practice-Informed Research & Research-Informed Practice		
Engage in Policy Practice		
Engage with Individuals, Families, Groups, Organizations & Communities		
Assess Individuals, Families, Groups, Organizations, & Communities		
Intervene with Individuals, Families, Groups, Organizations, & Communities		
Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities		

SUMMARY OF MSW FIELD SITE VISIT

	MSW Field Instructor	MSW Field Student	
	Below Expected Level	At Expected Level	Above Expected Level	Below Expected Level	At Expected Level	Above Expected Level	
OVERALL PERFORMANCE (Check one for Instructor and one for Student)		

		

RATING OF FIELD SITE AND FIELD INSTRUCTOR
PROVISION OF OPPORTUNITIES TO DEMONSTRATE COMPETENCIES

OPPORTUNITIES TO DEMONSTRATE COMPETENCIES	Site Provides Opportunities	Site Does Not Provide Opportunities	Field Instructor Provides Opportunities	Field Instructor Does Not Provide Opportunities	
Provides opportunities 
for MSW students to demonstrate competency in ethical and professional behavior		

Provides opportunities for MSW students to demonstrate competency in engaging diversity and difference in practice					
Provides opportunities for MSW students to demonstrate competency in advancing human rights and social, economic and environmental justice					
Provides opportunities for MSW students to demonstrate competency in engaging in practice-informed research and research-informed practice					
Provides opportunities for MSW students to demonstrate competency in policy practice					
Provides opportunities for MSW students to demonstrate competency in engaging with individuals, families, groups, organizations and communities					
OPPORTUNITIES TO DEMONSTRATE COMPETENCIES	Site Provides Opportunities	Site Does Not Provide Opportunities	Field Instructor Provides Opportunities	Field Instructor Does Not Provide Opportunities	
Provides opportunities for MSW students to demonstrate competency in assessing individuals, families, groups, organizations and communities					
Provides opportunities for MSW students to demonstrate competency in intervening with individuals, families, groups, organizations and communities 					
Provides opportunities for MSW students to demonstrate competency in evaluate practice with individuals, families, groups, organizations, and communities					

MSW Field Student recommends further use of this field site	Yes			No	
MSW Faculty Field Liaison recommends further use of this field site	Yes			No	

Please provide any additional comments below:

Comments continued:

MSW Faculty Field Liaison Signature
	Date