ࡱ> 574 ?bjbj// =EgEg1 .....BBB8zBK%}}}$$$$$$$$;')$.}}}}}$..%111}F..$1}$11#R$Pڧ#$%0K%#}*}* R$}*.R$d1}}}$$}}}K%}}}}}*}}}}}}}}}X : Evaluation Module: Sample Learning Contract Outline Opening Statement (outlining areas to be addressed & why): At the midterm evaluation, Sam received scores of 1 needs improvement for several items on Communication & Professional Behaviors on the AOTA FWPE (OT = 32, 33, 38, 39, 40); (OTA = 18, 19, 21, 22, 23). Goals & Objectives: Sam needs to consistently submit accurate online documentation each day before leaving the VA. Sam will prepare an agenda for weekly supervision meetings Context of Learning (e.g., on-site, off-site, in meetings, independently) On-site: meeting online documentation requirements and actively engaging in the interactive relationship with supervisor Methods of Evaluation (e.g., review, observed, reported) Supervisor will spot-check Sams documentation on a daily basis, accessing the online medical record Sam and FWE supervisor will collaborate on weekly learning objectives, demonstrated by a written agreement/plan that is co-signed & dated Duties/Responsibilities of student/FWE (e.g., collaborative vs. self-directed) Sam see above, Goals & Objectives. If Sam is uncertain about the content of documentation, Sam will ask FWE Supervisor to review a draft by no later than 3 p.m. FWE Supervisor: (1) will notify AFWC & Sites Student Program Coordinator of midterm results and to share learning contract; (2) will take responsibility to evaluate Sams performance for communication/documentation expectations; (3) will be available for support/consultation, re: quality and content of documentation. Timeline for review (e.g., daily, weekly, in 2 weeks, etc.,) Weekly supervision meeting collaborative review by Sam & FWE Supervisor In 2 weeks, formal review of AOTA FWPE items (OT = 32, 33, 38, 39, 40); (OTA = 18, 19, 21, 22, 23). Course of action if terms not met (e.g., termination/withdrawal/extension) If lack of consistent progress toward meeting the performance expectations is demonstrated, Sams Level II fieldwork placement may be prematurely terminated, in consultation with all parties: Sam, FWE Supervisor, AFWC, Sites Student Program Coordinator. Closing statement Sam & FWE Supervisor are invested in supporting Sams success on this Level II fieldwork placement. Both parties will demonstrate commitment toward their collaboration to work together. Co-signatures & Date     67r D E Y > V ^ a   0 SMLMN`fi012׷୥jhN?UhQfhQf5_H hu hQf5_H  h.5_H  h._H hGOYhQf_H hG0hQf_H hGOYhQf5_H hGOYhQf5CJ_H hD5CJ_H @67D E Y > V 0 S & FgdQfh^hgdQf & FgdQfgdQf)$$d%d&d'dNOPQa$gdDSMMN`134679:<=>?gdQf & FgdQf23456789:;<=>?hQfhQf5_H jhN?UhN? ;0P:pQf/ =!"#$% Dpx2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 44 G0Header  !4 4 G0Footer  !PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y ? < 2? S? 8@0(  B S  ?1 1 3 4 4 6 7 9 : < @ 1 @ EY^aN`fi 0 1 1 3 4 4 6 7 9 : < @ ^afi0 1 1 3 4 4 6 7 9 : < @ ljiPq $,Caz N|Y*hhh^h`OJQJo(hHh88^8`OJQJo(hHoh^`OJQJo(hHh  ^ `OJQJo(hHh  ^ `OJQJo(hHohxx^x`OJQJo(hHhHH^H`OJQJo(hHh^`OJQJo(hHoh^`OJQJo(hH^`o() ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.h^`OJQJo(hHh^`OJQJo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHohPP^P`OJQJo(hH^`o() ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH. N ,CjiTq@CJ$OJQJo("                                      ;_