SOWK: Performance and Verification of Experience HSV Candidate

Millersville University 
School of Social Work

Performance and Verification of Experience 
Home and School Visitor Candidate

STUDENT INFORMATION
Beginning Date of Evaluation Period
Beginning Date of Evaluation Period
End Date of Evaluation Period
End Date of Evaluation Period
Select Evaluation Timeframe
EVALUATOR INFORMATION
Instructions: Please rate the applicant by selecting the rating that corresponds to the learning objectives and characteristics.
Is this a field placement?
Is this employment?

In the space provided below, please provide the following information. The spaces provided do not have a minimum/maximum word count.

Recommended Action:


As the candidate's site supervisor, I am recommending the selection noted below based on my assessment of their performance and verification of their relevant experience.
Date of Evaluation Meeting:
Date of Evaluation Meeting:
Required Signatures:
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