Guidelines for MPH Programs in Canada

Appendix 8: Final Evaluation Form

Individual programs tend to have different final evaluation forms reflecting different levels of focus and required detail. The first example shows a relatively high-level evaluation form (not much detail) (see reference document 5), while the second example is more detailed (see reference document 8).

Example 1

Final Assessment of Student Practicum by Field Supervisor

• Student’s Name: 
• Practicum Setting: 
• Supervisor’s Name: 

Major areas of experience during practicum period:

By placing a check at the appropriate place on the scale, rate the student’s aptitude in community health and epidemiology.

excellent  average  poor  unable to judge 

Areas of outstanding ability: 

Areas of average competence: 

Suggestions for improvement in student’s preparation prior to arrival at the practicum setting: 

Recommendations for improvement in the practicum experience in subsequent years:

Suggestions for further training during remaining time in the MHSc program (e.g. arising out of knowledge or skill deficits observed during Practicum).

Other comments: 

Recommended Grade: 
Pass  Fail  Standing Deferred 

Guidelines:

The following three grade choices are available to the field-based practicum supervisor:

Pass  The student has satisfactorily performed in the practicum setting, and has demonstrated appropriate knowledge and skill in the community health field.

Fail The student has not performed in a satisfactory way and is not considered sufficiently well prepared for his/her level of training to date. Further formal education and/or practicum experience is recommended.

Standing Deferred The student has strong potential and it is recommended that further supervised practicum experience be gained prior to the completion of the practicum requirement.

Supervisor’s Signature  Date 

Student’s Signature  Date 

Please discuss this evaluation with the student.

Example 2

General Evaluation:

Check the number which best represents your answer. Five (5) represents the highest score, one (1) is the lowest score; N/A if not applicable.

• Drive and initiative
  High 5
  4
  3
  2
  Low 1
  N/A
• Priority setting: problem solving, decision making
  High 5
  4
  3
  2
  Low 1
  N/A
• Interpersonal skills: groups and individual Ideas and change
  High 5
  4
  3
  2
  Low 1
  N/A
• Planning organization/project/program _ development, management, evaluation
  High 5
  4
  3
  2
  Low 1
  N/A
• Computer techniques _ financial, management information systems, etc.
  High 5
  4
  3
  2
  Low 1
  N/A
• Problem analysis and solution
  High 5
  4
  3
  2
  Low 1
  N/A
• Basic research design of methodology, data collection and analysis, literature search
  High 5
  4
  3
  2
  Low 1
  N/A
• Communications _ conveying ideas persuasively, convincingly and concisely so that others can understand
  - verbal
  - written
  High 5
  4
  3
  2
  Low 1
  N/A
• Policy research, drafting legislation, negotiation, implementation
  High 5
  4
  3
  2
  Low 1
  N/A
• Assessment skills
  High 5
  4
  3
  2
  Low 1
  N/A

Overall Evaluation:

1. Did the student meet the objectives stipulated in the student’s learning contract for the Practicum Placement?
2. To what extent did the student’s work contribute to the mission and direction of your organization?
3. On the whole, how would you rate the student’s performance?
4. Do you or your program or agency wish to continue to provide supervised field practice placements in the future?
5. Additional comments (you may comment about the student and or provide feedback on any aspect of the UNM MPH Practicum Placement process, including the role of the Practicum program and staff at the UNM MPH Program):