Forms for Fieldwork Educators

Required prior to fieldwork

The Fieldwork Data Form is used to summarize information regarding the program at a fieldwork site. The Accreditation Council for Occupational Therapy (ACOTE) requires that a Fieldwork Data Form be completed prior to a student starting fieldwork at a site. Subsequently, this form should be updated annually. Please email the completed form to


Required during Level I fieldwork

Level I Fieldwork Evaluation is completed by the Fieldwork Educator and reviewed with the student. Please forward a copy of the completed evaluation form to Liz Kleine, Academic Fieldwork Coordinator, Level I at 450-30th Street, 4th Floor, Oakland, CA 94609. FAX 510-457-4008 or email:


Required during Level II fieldwork

The AOTA Fieldwork Performance Evaluation for the Occupational Therapy Student will be completed by the fieldwork educator at Week 6 (midterm) and Week 12 (final).  Each fieldwork educator will receive email instructions on how to complete this evaluation online.


Level II Fieldwork, Student Evaluation of Fieldwork Experience (SEFWE) is completed online by the student and reviewed with the fieldwork educator at Week 12. 


Optional communication tools during Level II fieldwork

Feel free to provide a copy of completed forms to the Level II Academic Fieldwork Coordinator, Domenique Embrey at


Level II Fieldwork, 4 Week and 8 Week Evaluation
This form is completed separately by both the student and the fieldwork educator and then reviewed together to promote ongoing feedback and communication over the course of fieldwork. 


The Fieldwork Experience Assessment Tool (FEAT) is a tool to promote communication and problem solving between the student and the fieldwork educator throughout the fieldwork experience. The FEAT examines 3 key aspects of fieldwork: the fieldwork environment, the fieldwork educator, and the student.


Learning Contracts are useful when specific professional or clinical behaviors require improvement. The learning contract is an agreement that is developed collaboratively by the student and the fieldwork educator. Sample templates (template 1, template 2) and a sample learning contract are provided.


Level II Fieldwork, Student Feedback Regarding Fieldwork Supervision Process
This form is completed by the student after Week 3 to reflect on how well the fieldwork experience is meeting his/her learning needs. The student's completed form is shared with the fieldwork educator in order to identify any adjustment that can be made to improve the student's comfort level and learning experiences.


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