College of Social Work: Republic of The Philippines Tamag, Vigan City 2700 Ilocos Sur

Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Social Work
SEMESTRAL PLAN
Second Semester, S.Y. 2021-2022
__________________________________
(Agency)
Date:
Over-all Goal:
Specific Objectives Program Tasks/Activities Persons Involved Time Frame Resources Needed Expected Output
Prepared by: Approved by:
__________________________ _____________________________
Field Instruction Student Agency Supervisor
Quirino Blvd., Brgy. Tamag, Vigan City, 2700 Ilocos Sur ISO 9001:2015
Website: www.unp.edu.ph REGISTERED
Certificate. No. SCP000580Q
Email: csw@unp.edu.ph
Tamag, Vigan City
2700 Ilocos Sur
SUMMARY OF ACTIVITIES
Time
Total
AM PM
Date Activity/ies
IN OUT IN OUT Hours Minutes
Prepared by: Approved by:
__________________________ _____________________________
Tamag, Vigan City
2700 Ilocos Sur

PROCESS RECORDING
Date: _________________
Activity: ______________________________________________________________________
Person’s Involved: ______________________________________________________________
Place: ________________________________________________________________________
PROCESS REMARKS
Prepared by: Noted:
_____________________________ __________________________
Tamag, Vigan City
2700 Ilocos Sur
FIELD INSTRUCTION II
Student’s Performance Evaluation Report
Student: Date:
Agency:
Agency Supervisor:
School Supervisor:
Period Covered:
Total hours of field practicum:
Student tasks and responsibilities:
This evaluation intends to give the student overview about his/her performance. Please
evaluate the student’s level of performance using the scale below. Please tick the appropriate box.
Indicate N/A in any area which is not applicable for evaluation.
5 – Outstanding
4 – Above average
3 – Progress Shown/Meets Expectations
2 – Progress Needed
1 – Does not meet expectations
I. Student’s ability to develop capacity to work with the 1 2 3 4 5 N/A
agency structure and function (25%)

1 Student is punctual in attendance and complies with
work requirements diligently.
2 Student demonstrates ability to establish professional
relationship with staff and with the client system.
3 Student exhibits ability to avail and use supervision to
learn or improve work.
Comments and recommendations:
Tamag, Vigan City
2700 Ilocos Sur
II. Student’s knowledge/skill on how to bring needs and 1 2 3 4 5 N/A
resources together (15%)

1 Student is able to show knowledge of the agency’s
vision, mission, philosophy, policies programs, services
and procedures.
2 Student demonstrates ability to interpret agency’s
VMGO to clients and outside resources.
3 Student displays ability to mobilize and use community
resources
III. Student’s ability to gain knowledge/skills in problem 1 2 3 4 5 N/A
solving (40%)
1 Student is able to gather accurate data, as well as
relevant and adequate information through the use of
different methods of data gathering.
2 Student is able to identify problems and make clients
aware of the problem.
3 Student is able to engage or see the causal relationship
of problems.
4 Student is able to involve client in objective setting
and engage him/her in the program development
process.
5 Student is able to identify activities/projects to achieve
objectives.
6 Student is able to implement an action plan, get
cooperation of the client system to carry out tasks or
projects, and identify or create and use community
resources.
7 Student is able to sustain interest and deal with client
system to reach set goals.
8 Student has the ability to organize groups and identify
leaders.
9 Student is able to use different intensive of
interventive approaches, techniques, and strategies.
10 Students is able to transfer knowledge and skills to
client group.
11 Students is able to assess effectiveness of interventive
techniques, programs and services.
12 Student is able to assess how client system reacts to
professional help.
Tamag, Vigan City
2700 Ilocos Sur
IV. Knowledge/Skills in documenting Social Work Practices 1 2 3 4 5 N/A
(20%)
1 Student is able to record accurately the helping
process.
2 Student is able to record how client reacts to
professional help.
3 Student is able to prepare different types of recording.
4 Student is able to prepare administrative records.
Areas of strength
Areas that need improvement
My agency supervisor has discussed this evaluation with me. I have with me a copy.
I agree with the evaluation as indicated.
______________________________________ ______________________________________
Student’s signature Agency Supervisor’s signature
______________________________________ ______________________________________
Date Date
I disagree with the evaluation as indicated. Appended is a copy of areas of disagreement.
______________________________________ ______________________________________
Student’s signature Agency Supervisor’s signature
______________________________________ ______________________________________
Date Date
(copy furnished to student, agency supervisor, school supervisor, field instruction coordinator and the dean of the College of Social Work.)
Tamag, Vigan City
2700 Ilocos Sur

FIELD INSTRUCTION I/II
Student’s Self and Field Practicum Evaluation
Student: Date:
Agency:
Agency Supervisor:
School Supervisor:
Identify and describe your best experiences in your field practicum.
Identify and describe what you like least from your experiences in your field practicum.
Describe your relationship with your agency supervisor, agency staff, and your fellow
fieldwork students (if there are any). How was the quality of supervision of the agency during
your field placement?
Tamag, Vigan City
2700 Ilocos Sur
Please describe the learning opportunities you had in your fieldwork. How did these learning
opportunities influence your experience?
Student’s Signature: ___________________________________________ Date: ____________
Field Supervisor’s Signature: ____________________________________ Date: ____________

(copy furnished to student, agency supervisor, school supervisor, field instruction coordinator and the dean of the College of Social Work.)
Tamag, Vigan City
2700 Ilocos Sur
DAILY TIME RECORD

-----o0o-----
_____________________________________________________________________________________
(Name)
For the month of
A.M. P.M. Undertime

Day
Arrival Departure Arrival Departure Hours Minutes
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total
I certify on my honor that the above is a true and correct report of the hours of work performed, record of which was made daily at the time of arrival
and departure from office.
Field Instruction Student
Agency Supervisor

College of Social Work: Republic of The Philippines Tamag, Vigan City 2700 Ilocos Sur

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College of Social Work: Republic of The Philippines Tamag, Vigan City 2700 Ilocos Sur

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

College of Social Work

Prepared by: Approved by:

College of Social Work

Prepared by: Approved by:

College of Social Work

Prepared by: Noted:

College of Social Work

agency structure and function (25%)

II. Student’s knowledge/skill on how to bring needs and 1 2 3 4 5 N/A

resources together (15%)

III. Student’s ability to gain knowledge/skills in problem 1 2 3 4 5 N/A

Comments and recommendations:

IV. Knowledge/Skills in documenting Social Work Practices 1 2 3 4 5 N/A

Areas that need improvement

I agree with the evaluation as indicated.

I disagree with the evaluation as indicated. Appended is a copy of areas of disagreement.

College of Social Work

Identify and describe your best experiences in your field practicum.

Student’s Signature: ___________________________________________ Date: ____________

Field Supervisor’s Signature: ____________________________________ Date: ____________

DAILY TIME RECORD

For the month of

A.M. P.M. Undertime

Field Instruction Student

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Student’s Signature: _______________________________ Date:

Field Supervisor’s Signature: ________________________ Date: