Community Practicum I-III Final Review Form

COMMUNITY PRACTICUM I-III
FINAL REVIEW
Student:
Student's Email:
example@example.com
Year/Practicum level:
Community:
Practicum Supervisor:
Practicum Supervisor's Email:
example@example.com
Practicum Coordinator/ Class Advisor:
Practicum Coordinator/ Class Advisor Email (please only list one email):
example@example.com
In preparation for your final review, please review your completed learning agreement and mid-year review and have a copy of both on hand to refer to during your conversation with your Practicum Supervisor.
Section 1. Primary responsibilities: Describe any significant changes to your practicum responsibilities, including to the setting, schedule, or goals. If there are no significant changes to report, write "N/A".
Section 2. Reflection and self-assessment: Comment briefly on your experience in the practicum, in general, but especially with regard to your primary learning goals and capacity areas you are developing.
What's been successful?
What's been challenging?
What new insights have you gained?
What's something you might do differently as a result of what you learned this year?
Do you have any feedback for your supervisor about your working relationship during this practicum? Please share any comments, concerns, or suggestions that could help strengthen the supervisory experience.
Are there any other areas for further development or capacity-building? If you continue to the next stage, how might this influence your goals and activities in next year's practicum?
Section 3. Collegial Feedback: In individual or group conversations with the Practicum Supervisor, what feedback do other colleagues and fellow community members have for the Student about the learning goals and development across relevant capacity areas? Anonymize names unless given explicit permission.
Section 4. Practicum Supervisor Feedback: What advice or direction can you provide, in general and specifically with regard to the learning goals and the development across relevant capacity areas? Include any concerns or issues that need to be referred to the Practicum Coordinator/Class Advisor for further action. If the Student is at risk of not passing the practicum, you, the Practicum Supervisor, must notify your Practicum Coordinator/Class Advisor. If attention or remediation is needed, indicate the date the Practicum Coordinator/Class Advisor was notified in the field below and attach additional documentation, such as a remediation plan.
Section 5. Additional comments: If there is anything else anyone would like to share or elaborate on further, please do so here. If not, you may leave this field blank.
Grade (mark one):
By signing this Final Review Form, you confirm the information above is an accurate reflection of your conversation. Once completed and signed, a copy will be automatically sent to the Program Administrator to file in your student record. You, the student, should retain a copy and refer to it when completing the Learning Agreement for the Community Practicum with your Practicum Supervisor next year.
Student's signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Practicum Supervisor's signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Program Administrator's Email:
example@example.com
Should be Empty:

COMMUNITY PRACTICUM I-III

FINAL REVIEW