School of Social Work Appendix B - Joint MSW Field At Place Of Employment Proposal

School of Social Work
APPENDIX B
Joint MSW Field At Place Of Employment Proposal

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Students wishing to do their field at their place of employment must submit, to the Field Coordinator, a written proposal for the field experience. The proposal must conform to the guidelines listed below and demonstrate how the proposed experience meets the requirements of the Field Education Program.

I. Student Information

Date of Submission:

Student’s Name:    Student ID #:

Phone:         (H)          (W)                  Email:

Curriculum Track (check all that apply): Advanced Standing Full-time Part-time    Micro Macro

II. Agency Description

Agency Name:

Agency Address:

Agency Mission (please provide in the space below):

Types of programs/services provided by the agency:

Target population(s) served:

III. Student Employee Status

Job Title:

Job Description:

Length of time employed at the agency:

Documentation of successful completion of probationary period needs to be attached to this form in order for you to be considered
for Field at Place of Employment.

Name of immediate employment supervisor:

Phone Number of employment supervisor:

Email of employment supervisor:

IV. Proposed Field Experience

A. Specify the social work activities, assignments and other involvements to be engaged in as part of the field experience. The proposed activities, assignments, and other involvements must be different from those that are a part of the student’s employee job description.

B. Describe what you hope to learn from the above experiences.

C. Describe how field will be distinct from normal work in terms of both proposed assignments and time frame. Field time should be planned and specified to maintain learning boundaries as well as opportunities, optimally in blocks of three or more hours and absolutely not less than one hour so the student learning experience is well defined.

D. Describe how the agency agrees that to support the student’s learning contract and commits to covering student employment activities as needed to facilitate these goals.

V. Proposed Field Instruction

Proposed Field Advisor name:

Proposed Field Advisor phone number:

Proposed Field Advisor email:

Proposed Field Advisor degree:

Proposed Field Advisor title/position:

The proposed field instructor must be someone other than the student’s immediate employment supervisor; must have MSW or MSSA degree (no non-social work degree is accepted); must have two years postmaster’s experience; and must have a minimum of one year with the agency.

VI. The Proposal

A. Must be typed and double-spaced, using the above outline

B. Must include, at the bottom, the signatures of the student; his or her immediate employment supervisor; and the proposed field instructor, including academic degree.

C. Will be accepted contingent upon its conformity with the Program requirements for field at place of employment.

Agency or Social Work Director signature Date: _________________________________________________________________

(please sign even if same as any of the above)