Family Life Education Practicum This contract is due one week after the initial site visit by the faculty coordinator.
Learning Contract
Name of Student______________________________________________________________
Student's home address_________________________________________________________
___________________________________________________________________________
Name of agency/placement site___________________________________________________
Address of agency/placement site__________________________________________________
_____________________________________________________________________________
Agency telephone number____________________Home telephone number__________________
Name of field placement supervisor__________________________________________________
Semester enrolled___________________ Credit hours______________Contact hours_________
Inclusive dates of the contract, from __________________ to ____________________________
Days and hours of the week:
Mon._______Tues._______Wed._______Thurs_______Fri._______Sat._______ Sun._______
Proposed days off (holidays, WMU breaks, other)_____________________________________
______________________________________________________________________________
On a separate sheet of paper, please provide the following information:
1. Goals and outcome statements for the student
2. Agency/organization site expectations
(This information should be provided by the site supervisor and should include outcome expectations and agency policies. Policies might be included in the agency's policies and procedures manual and can simply be attached to your learning contract.)
3. List and discuss any potential problem areas and your plans for problem solving.At the end of your learning contract, there should be a signature block like the one below:
Student___________________________________________ Date________________
Site supervisor_____________________________________ Date________________
FLE faculty coordinator______________________________ Date________________
Three copies of the learning contract with original signatures should be submitted to the FLE faculty coordinator. Two copies with all required signatures will be returned to you, one for your records and one for you to give your site supervisor for their records.
FLE Final Evaluation Date__________________
Cover sheet
A grade of "I" (incomplete) will be recorded if the final evaluation is not received by the last day of the semester. The incomplete will be removed when the required materials have all been submitted. You have a period of one year to have an incomlete changed to grade/credit.
Name of student_______________________________________________________________
Social Security Number_________________________________________________________
Student's home address_________________________________________________________
____________________________________________________________________________
Agency name and address________________________________________________________
_____________________________________________________________________________
Agency telephone______________________________Home telephone____________________
Name of site supervisor__________________________________________________________
Semester_______________________________________
Clock hours completed to date_______________________
In a notebook with tabs, please provide the following information:TABS:
1. Your goals and outcome statement and documented achievement of the goals/outcomes.
2. Your journal and a separate summary of your experience. Documentation of the time spent on the project must total a minimum of the required hours.
3. Identify specific areas of content covered in the FLE experience. (see Major Topics and identify by subject matter areas)
4. Your personal plan. Identify individual strengths and weaknesses and suggestions for further professional development and improvement. Discuss your professional growth and development.
Submit an example video tape of at least 20 minutes duration as a "demonstration tape" sharing typical daily activity.
Please return by___________
616/387-3704 or FAX 616/387-3353
Western Michigan University Intern Name____________________________________________________________________
Family and Consumer Sciences
Supervisor Evaluation for Practicum
Intern Job Title__________________________________________________________________
Agency Name__________________________________________________________________
Agency Address________________________________________________________________
Supervisor Name_______________________________________________________________
Supervisor Title_____________________________ Phone/Ext._________________________
Directions: Please rate the intern in the following categories
Superior Good Average Poor
Management/Organizational AbilitiesLeadership and Iniative 20 18 15 12 9 6 3 0
Motivation & Delegation Skills 20 18 15 12 9 6 3 0
Organizational & Planning Skills 20 18 15 12 0 6 3 0
Prioritizing Skills 20 18 15 12 9 6 3 0
Problem Solving Skills 20 18 15 12 9 6 3 0Interpersonal Abilities
Communication Skills 20 18 15 12 9 6 3 0
Conflict Management Skills 20 18 15 12 9 6 3 0
Empathy Skills 20 18 15 12 9 6 3 0
Human Relation Skills 20 18 15 12 9 6 3 0
Resourcefulness 20 18 15 12 9 6 3 0
Professionalism/Related
Attendance & Punctuality 20 18 15 12 9 6 3 0
Attitude ------------------------- 20 18 15 12 9 6 3 0
Dependability 20 18 15 12 9 6 3 0
Initiative & Achievement 20 19 15 12 9 6 3 0
Judgement 20 18 15 12 9 6 3 0
Knowledge 20 18 15 12 9 6 3 0
Professionalism 20 18 15 12 9 6 3 0
Quality of Work 20 18 15 12 9 6 3 0
OVERALL PERFORMANCE 40 35 30 25 20 15 10 0
Total _____
Comments: ________________________________________________________________________________________________________________________________________________
____________________________________________________________________________
.
Total hours worked from ________________ to___________________= _______ hours
_______________________________ _______ _____________________________ ______
Student Intern Date Supervisor Dtre
