CONTACT: Professor Christina Lesyk, LMSW, HS-BCP Practicum Coordinator Tel.: (315) 386-7836 Email: lesykc@[Link] HUSV 421 STUDENT EVALUATION FORM Please feel free to adjust spacing or attach extra pages as needed. Please forward completed evaluation to: Professor Christina Lesyk, SUNY Canton Practicum Coordinator, SUNY Canton, at lesykc@[Link]. Thank you! TYPE OF EVALUATION (Please check one): Midterm (Due by Week 8) X_ Final (Due by Week 15) Student Name: 2024 Semester: Spring_X_ Year ‘Agency Name: Northern Rivers Agency Address: 375 Bay Road Suite 203, Queensbury NY 12804 Agency Supervisor/ Evaluator’ Name (Type or Print) Aerielle Jasper Title/Position: “Health Home Care Manager Supervisor Telephone:( 518 ) 801-4952 Email: Aerielle jasper@[Link] INSTRUCTIONS: Based on your interactions, observations, and/or other feedback from other staff, clients/patients, and others, please rate the student on each of the following work-related skills listed below. Your assessment ratings should range from 5 (high) to 1 (low). 5 = Exceptional (always demonstrates this ability/consistently exceeds expectations). A-level grade. 4= Above Average (Frequently demonstrates this ability/occasionally exceeds expectations. Brlevel grade. Revised: 1/8/20243 = Average (Typically demonstrates this ability/meets expectations). C-level grade. 2= Below Average (Sometimes demonstrates this ability/sometimes meets expectations). D-level grade. 1 = Not Satisfactory (Rarely demonstrates this ability/does not meet expectations). F-level grade. Able to find and utilize appropriate resources. Exceptional (5) ‘Above ‘Average (4) ‘Average 3) Below 2 Average | Satisfactory Not IsLo 1) 2 | Accepts responsibility for mistakes and learns from experiences. 3 | Observes and/or pays attention to others. La 4 | Open to new challenges and experiences. 1. [Shows understanding of organization's customs and practices. 2. | Consistently proceeds using the highest ethical standards. 2,4, 3. | Fulils role and performs responsibilities as determined by the Student Learning, Contract. 4 [Acquires and critically evaluates information. Revised: 1/8/2024Exceptional (5) Seeks to comprehend and understand issues in detail and in their larger context. ‘Above Average (4) ‘Average (3) Below Average Not Satisfactory 1 2 | Respects input and ideas from other x sources and people. 3 | Demonstrates problem-solving capacity, accurately and appropriately applies knowledge to the task cr solution of problems. 1,2, 4 | Exhibits understanding and use of ethical considerations. 1 | Reads, comprehends, 4 | Verbally communicates ideas and concepts clearly, accurately, and appropriately. and follows written x materials. 2 | Communicates ideas 1 and concepts clearly, accurately, and x appropriately in writing. 3 [Listens to, 1 comprehends, and follows verbal x instructions. 1 Revised: 1/8/2024Exceptional | Above ‘Average | Below Not (5) Average (3) Average | Satisfactory | ISLO (4) (2) (1) 1 | Accepts and participates x actively in supervision. 2 [Demonstrates x a teamwork 3 | Demonstrates caring a and respect with x clients/patients. 4 | Does not allow personal 4 issues to interfere with professional performance. 7 TOTALOFCOLUMNS| 3 13 a || PLEASE RESPOND TO THE FOLLOWING (please feel free to add extra pages as needed): The student was most effective in: Being open to new challenges and experiences, Aidan shows exceptional enthusiasm n participating in this internstip and gaining knowledge from Superisot and Staff, Aidan is eager to go on home visits, leam about the Netsmart programing and paperwork requirements of the program, and how to develop and navigate relationships vith cients. Aidan completes any tasks asked of Supervisor dligently and eager The student needs growth in: Due to Aidan being so new to the program and the many moving parts, Aldan would benefi from continued grow in learning how to ‘entfy client ness and communi resources, as well as how to help cents implement them. As the intemship continues, Aidan wil Work with Supervisor on completing a Pian of Care for lent and idertfying the objectives and resources the clientfamlly need. This |s.a ski that offen takes time and continued practice to develop. Additional recommendations/comments: ‘Aidan has been a pleasure to work with and is very kind, courteous and respectful to supendsor and staff, as well as the clentele he has been inroduced to, Aidan i always willing to help and is very detailed and thorough. Aidan takes notes consistenly and ‘eels comfortable folowing up with Supervisor on any questions that arise. Date that this evaluation was discussed with student: Agency Supervisor/ Evaluator’s Signature: pate: _B/o/2y Revised: 1/8/2024Revised: 1/8/2024