A Completed Example, Can Be Downloaded from the HDFS Field Ed Website

*ATTENTION Students! This document is considered a formal agreement between you and your field site, and should only be submitted to the HDFS Field Education Program Office once a clear commitment has been made between you and your Field Mentor. The hosting agency/organization indicated here MUST be the same as the one from whom you previously submitted the Intent to Place Packet. Once submitted, this agreement can only be terminated through completion of an official Termination of Placement form. A completed example, can be downloaded from the HDFS Field Ed website >>THIS DOCUMENT MUST BE SUBMITTED IN HARD COPY BY THE POSTED DEADLINE TO THE LOCKBOX OUTSIDE Waldo 401<<

Instructions for completing this Learning Plan

Students should complete the “Planned Learning Activities” in collaboration with the assigned Field Mentor. Students should NOT simply send or give this document as a blank form to your assigned Field Mentor and ask them to fill it out. Instead, you should find out from your Field Mentor how they prefer to go about completing this document with you – whether in a series of in-person meetings, through email exchanges, or a combo of both – and set up those meetings as soon as you have completed the Intent to Place materials.

With substantial input from the Field Mentor, the student should fill the space provided under Planned Learning Activities with the specific tasks, activities, or projects in which the student will be engaged in order to grow their competency in each dimension of Human Service practice (broken down in the left-column). The planned activities should be written with enough detail/description such that our program staff, though we are not closely familiar with the agency’s work, will be able to grasp the learning connection between the activity and the given objective. Please keep in mind that students are expected to receive progressively more responsibility and independence, with appropriate supervision, over the course of the placement.

This form has been designed to align with the standards for the introductory 209-level internship. For Competencies 1 through 5 students should engage in at least one learning activity for EVERY objective. *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name:

Competency 1 – Values and Attitudes Behavioral Objectives: Field Work Evaluation Ratings “As appropriate in this Planned Learning Activities: (see separate instructions) practice setting, the “To achieve this behavioral objective, Mid: Final: Self Final: students will grow in the student will be asked to…” Self Field their capacity to…” Mentor A. Apply the NOHS Code of Ethics to real and hypothetical situations B. Demonstrate appropriate professional boundaries and maintenance of confidentiality C. Communicate and apply understanding of the importance of the diverse identities and experiences that shape the lives of individuals, families, and communities D. Demonstrate professional demeanor in behavior, appearance, and all forms of communication E. Use supervision and consultation to guide professional judgment and behavior

Competency 2 – Interpersonal Skills Behavioral Objectives: Field Work Evaluation Ratings “ (see separate instructions) As appropriate in this Planned Learning Activities: practice setting, the Mid: Final: Self Final: “To achieve this behavioral objective, the student will be asked to…” students will grow in Self Field their capacity to…” Mentor *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name: A. Clarify expectations with clients or co- workers B. Establish rapport with clients and co-workers C. Be open and responsive to constructive feedback D. Work as an effective team member

Competency 3 – Historical and Political Context Behavioral Objectives: Field Work Evaluation Ratings “ (see separate instructions) As appropriate in this Planned Learning Activities: practice setting, the Mid: Final: Self Final: “To achieve this behavioral objective, the student will be asked to…” students will grow in Self Field their capacity to…” Mentor A. Draw relevant connections to the historical and political background of this arena of service delivery

B. Apply an understanding of how historical and current social policies affect outreach and service delivery today

Competency 4 – Social Factors in Human Wellness Behavioral Objectives: Field Work Evaluation Ratings “ (see separate instructions) As appropriate in this Planned Learning Activities: practice setting, the Mid: Final: Self Final: “To achieve this behavioral objective, the student will be asked to…” students will grow in Self Field their capacity to…” Mentor A. Describe the *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name: characteristics and needs of the population(s) served and the range of services delivered by this agency and its collaborators B. Describe and apply the key theories (‘models of change’) used by this agency and its programs in delivering services C. Apply an understanding of how interpersonal and cultural dynamics of power and privilege impact the needs for services in the population as well as service delivery

Competency 5 – Information Management Behavioral Objectives: Field Work Evaluation Ratings “ (see separate instructions) As appropriate in this Planned Learning Activities: practice setting, the Mid: Final: Self Final: “To achieve this behavioral objective, the student will be asked to…” students will grow in Self Field their capacity to…” Mentor A. Obtain information through interviewing, active listening, consultation with others, library or other research, and the *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name: observation of clients and systems. B. Record, organize, compile, synthesize, and categorize information using current software standards (word processing, email, spreadsheets, etc.) C. Deliver both oral and written information to clients, colleagues, or other collaborators in an effective and professional manner.

Evaluation Comments: (Both student and Field Mentor are asked to provide constructive criticism as well as positive feedback here AND to discuss these comments in person before submitting this evaluation; Please type for readability; These boxes will expand to allow as much space as needed). Mid: Self Mid: Field Mentor

Final: Self Final: Field Mentor

VERIFICATIONS Signature (actual signature required) Printed First & Last Date Name Learning Plan Completion *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name: Student

Field Mentor

Mid-term Evaluation Number of Hours Completed to Date = ______Student

Field Mentor

*Please be sure to discuss this evaluation with your student in person. End-of-Term Evaluation Number of Hours Completed to Date = ______Student

Field Mentor

*Please be sure to discuss this evaluation with your student in person. *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name: Instructions for Evaluation of Student Performance

TO COMPLETE THE EVALUATION FORM: Both students and Field Mentors should enter a numeric rating (according to the rubric below) for every objective where one or more learning activities is entered. At the end of the grid, space is provided for written comments on any of the competencies, or general comments that are not connected to a particular competency. Experts have shown that written, qualitative comments are more useful to learners than are numeric ratings when trying to adjust and refine professional behaviors. We strongly encourage Field Mentors to offer written comments whenever possible, but particularly for an objective on which a lower numeric rating is given. Both students and Field Mentors are encouraged to remember that feedback, both positive and constructively critical, is essential for growth.

MID-TERM - Use only these ratings for the mid-term ratings FINAL - Use only these ratings for the final ratings Rating: Definition: Rating: Definition:

2 Right on Track: Meeting Expectations. 5 Exemplary: Excelled. “Seeing progress on this objective and anticipate the student will “On this objective, this student is now one of the most skilled I’ve meet or exceed expectations by term’s end.” seen. S/he is a great example of this professional competency.”

1 Progress is Lagging: Below Expectations. 4 Ready to Practice: Somewhat above expectations. “Not seeing what I would expect at this stage. I have some concerns “No question that student has mastered this objective. S/he is about student’s ability to achieve this.” completely competent in this area.”

N/A Not Applicable: No opportunity to evaluate this thus far 3 On the Cusp: Met expectations. “I have observed definite growth on this objective. The student needs only a bit more practice to be ready.”

2 Needs more Training: Somewhat below expectation. “I had hoped to see a bit more growth here. In this area, student is not quite ready for practice.”

1 Unsuitable for Practice: Significantly below expectations. “The student has little competency here. Much more development is needed for competency.”

N/A Not Applicable: No opportunity to evaluate this thus far

Mid-term ratings are intended entirely as “formative” evaluation – a way of structuring feedback and focusing attention on areas of needed improvement. A “Progress is Lagging” (below expectations) rating at the mid-term assessment will have no impact on the student’s grade. At the final evaluation, students must achieve at least the “On the Cusp” (met expectations) rating for all objective to successfully pass their field education course (HDFS 209 or HDFS 410). *THIS DOCUMENT IS DESIGNED WITH EXPANDING FIELDS TO ALLOW AS MUCH SPACE AS NEEDED* Student Name: **COMPLETED EXAMPLES OF THIS FORM ARE DOWNLOADABLE FROM THE HDFS FIELD EDUCATION PROGRAM WEBSITE**