II. Agency Description
III. Student Employee Status
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.
Proposed Field Experience
Proposed Field Instruction
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.
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)