MSW 593 and MSW 594
Concentration Year Field Instruction
Evaluation Project Proposal Form
Concentration year field instruction students are required to participate in a field practicum agency
sponsored evaluation project. Students are encouraged to discuss potential evaluation projects with their
assigned agency field instructor during the first week of the practicum placement and be prepared to
further review these options with the Faculty Field Liaison during the first agency visit.
Before any evaluation project is started, however, it must be reviewed and approved by faculty of the
School of Social Work to insure that it conforms to curriculum expectations, that the agency has provided
adequate protection for human subjects, and to assess need for referral to the St. Ambrose University
Institutional Review Board.
Respond to each of the following items below and submit this form (and attached narrative) to the
Faculty Field Liaison. Drafts due to FFL no later than October 14, 2011; this may be turned in any time but
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final approved copy needs to be turned in no later than November 4 , 2011. Scheduled meeting for
Faculty Review/Approvals is November 9, 2011.
Your Name Faculty Field Liaison
Agency Agency Field Supervisor
Address in full the following:
1. Summarize the purpose and objectives of the Evaluation Project.
2. Describe your role in the Evaluation Project and the role of other agency evaluators (i.e., Will you
be primarily responsible or is this an existing project in the agency?).
3. Delineate the data collection process of evaluation including:
Instruments
Sample
Time frame
Process of insuring informed consent
4. Please check “yes” or “no” to the following:
a. Has this Evaluation Project been developed in agreement with the Agency Field
Supervisor? Yes No
b. Has this Evaluation Project been reviewed by your Faculty Field Liaison?
Yes No
c. Is the proposed Project consistent with the ethical standards for evaluation and
research as described in Section 5.02 of the NASW Code of Ethics (2008)?
Yes No