Student Name: DEPARTMENT f SOCIAL WORK Applicatin fr MSW Field Practicum Directins: The field educatin prcess is a partnership invlving the scial wrk prgram, field educatin department staff, scial wrk faculty, field placement sites, field instructrs and scial wrk students. Yur mindful, thrugh, cmpletin f this applicatin supprts that prcess and allws us t mve frward in develping a psitive field placement. Students wh return incmplete r late practicum applicatin and/r d nt actively cllabrate with field educatin staff will risk delayed entrance int field and subsequent delay in cmpleting field requirements. It is essential that yu review the Field Educatin Manual prir t cmpleting this applicatin. This will help yu t understand the specific requirements f yur field placement and the field educatin prcess. The Manual and electrnic versins f all dcuments are available n the Scial Wrk Website Field Educatin Page: http://www.westfield.ma.edu/academics/scial-wrk-department/field-educatin Cmplete the applicatin electrnically. Click the apprpriate check bxes and/r type infrmatin in the text bxes. Be sure t save yur cmpleted applicatin in the fllwing frmat: last name,first name,fieldapp (i.e. Smith,Jane,FieldApp.pdf ). The applicatin is nly cnsidered cmplete when an electrnic cpy f a current resume is als prvided as a separate dcument. A current resume shuld include yur status as a scial wrk student and any related scial wrk experience (i.e. previus internships, vlunteer experience, etc.). Prvide an electrnic cpy f the cmpleted applicatin by the Due Date t: Terri Haven, Field Educatin Directr at: thaven@westfield.ma.edu I am currently enrlled in: MSW, Westfield MSW, Wrcester MSW 2 Year Full-time Prgram MSW 3 Year Part-time Prgram MSW 4 Year Part-time Prgram MSW Full-time Advanced Standing Prgram MSW Part-time Advanced Standing Prgram Revised Nvember, 2017
Please check all that apply: I am applying fr an MSW Fundatin Year Field Placement I am applying fr an MSW Advanced Year Field Placement in the Traditinal MSW Prgram I am applying fr an MSW Advanced Year Field Placement in the Advanced Standing MSW Prgram I am applying fr an Emplyment Based Field Placement (additinal applicatin required) I am applying fr the IBHC Fellwship (advanced year nly; additinal applicatin required) NOTE: If applying fr placements that require an additinal applicatin, please review the sectin in the Field Educatin Manual that discusses the particular type f placement. Yur applicatin will nly be cnsidered cmplete when bth yur primary field applicatin and the additinal applicatin are received. As with all placements, the final apprval fr placements is made by the Field Educatin Department. My Cntact Infrmatin: 1. Best Phne number t cntact me: Des this Phne number change during Semester Break r during the Summer Mnths? Yes N If yes, please prvide the best Phne number t reach yu during thse times: 2. Email Address: Yur Westfield State email address is cnsidered t be yur primary email address, bth during the academic year and the summer. Yu are expected t check this email regularly as this will be the primary way the field department will cmmunicate with yu during the field educatin prcess. FIELD PLACEMENT INTERESTS AND EXPERIENCE While meeting yur educatinal needs and prgram requirements are necessarily the first criteria fr field placement, yur preferences are als cnsidered. It is imprtant fr yu t understand that, while yur preferences will be cnsidered t the extent pssible, this des NOT mean that all f yur preferences can/will be met in yur field placement assignment. Client Ppulatin/Setting Are there specific client ppulatins and/r settings (i.e. children, lder adults, immigrants) r practice areas (i.e. addictins, child welfare, medical facilities, residential services, schls, etc.) yu are particularly interested in? Please discuss yur interest (including why these ppulatins interest yu and what, in particular, interests yu abut these ppulatins) and any previus experience yu have in any f these areas? Revised Nvember, 2017
Lcatin f the Placement Depending n the lcatin yu attend classes, students shuld expect t cmplete their field placements in a lcatin that is within n mre than a sixty-mile radius f Westfield State University in Westfield OR within n mre than a 30 mile radius f Westfield State University in Wrcester. Is there a particular gegraphic lcatin/twn within this radius that yu prefer t cmplete yur field placement? Yes, please specify lcatin and reasn: N Yur address during the timeframe yu will be cmpleting yur field placement: Street: City, State: Transprtatin D yu have a valid driver s license? Yes N D yu have access t a car fr travel t and frm yur field placement? Yes N If yu answered N t either f the abve questins, hw will yu travel t and frm yur field placement? Yur Availability Generally, placements begin in September and end in early May f the fllwing year, with an verall requirement f either 400 hurs (16 weekly) fr the Fundatin Placement r 500 hurs (20 weekly) fr the Advanced Placement. It is crucial that yu review the sectins f the Field Educatin Manual that detail the plicies related t eligibility fr placements. Students are expected t d mst r all f their placement hurs during regular daytime business hurs. While sme evening and weekend hurs may be arranged under certain rare circumstances, and may be available t students enrlled in a parttime prgram, there are very few placement sites that ffer evening and weekend placement hurs, especially with the required level f supervisin. In additin, all students are required t participate in at least sme regularly scheduled agency staff and clinical meetings, which are generally held during daytime hurs, in rder t gain the full experience f wrking in a scial service envirnment. Mst students find it is easier (and mst sites strngly prefer r require) t set aside tw r three days with lnger timeframes instead f trying t wrk nly a few hurs ver several days. Please list yur availability (start and ending times i.e. 8am 4pm). Als, please keep in mind that yur Scial Wrk classes are held in sme cmbinatin f Mnday evening and Thursday evening depending n the prgram yu are enrlled. Mnday Tuesday Wednesday Thursday Friday Sat/Sun Revised Nvember, 2017
ADDITIONAL INFORMATION If yu have reasn t believe that a specific agency/rganizatin is available t yu fr a field placement, please prvide that infrmatin here (including agency/rganizatin name and specific cntact persn s name, email address and phne number) and we will cntact the persn t discuss field placement requirements and whether r nt an Affiliatin Agreement can be established between the site and Westfield State University. We always welcme yur ideas fr new placement pssibilities. Please remember that students are nt allwed t make arrangements fr a specific field placement withut the cllabratin and apprval f the Field Educatin Department: D yu have any particular skills r qualificatins that may apply t specific client ppulatins r practice areas (i.e. fluent in a language ther than English, CPR training, licenses, etc.)? N Yes, please explain: Have yu cmpleted previus field placements? Yes N If yes, please describe the lcatin f the placement, nature f the placement(s), the aspects f the placement(s) yu felt mst useful. Mst human service rganizatins are required t perfrm any/all f the fllwing checks befre accepting students fr placement: Criminal backgrund (CORI) either n a state r natinal level Sex Offender Registry Prtective Service agencies will check t see if student applicants have histries f invlvement with Prtective Services. Sme rganizatins may have additinal requirements regarding medical clearances prir t acceptance. Additinally, students may nt be placed in settings where there is a ptential r knwn cnflict f interest and/r dual relatinship. Students are strngly encuraged t discuss any circumstances that may disqualify them fr certain placements with a member f the field educatin staff s that apprpriate placement assignments may be made and that yu are nt cnsidered fr a placement where yu may ultimately nt be accepted. Yur respnses t the fllwing will help us t select apprpriate placements: Revised Nvember, 2017
Are there any reasns yu culd nt cmplete a field placement in a specific agency due t a cnflict f interest and/r ptential dual relatinship (i.e. have previusly wrked there and/r have relatives r friends that wrk there, yu r a family member receive(d) services there, etc.)? Students with questins abut whether r nt a specific situatin invlves a dual relatinship r a cnflict f interest shuld discuss their specific situatin with their assigned field educatin staff. Yes N If yes, please explain: Have yu ever been cnvicted f a crime (misdemeanr and/r felny) and/r have a negative CORI and/r criminal histry in Massachusetts r any ther state? Yes N Are yu currently, r have yu ever been, a client with the Department f Children and Families (DCF, frmerly the Department f Scial Services, DSS) in Massachusetts r any ther state? Yes N D yu have a dcumented disability that yu expect t make a request fr reasnable accmmdatins within a field placement? Yes N If yes, yu must cntact the Banacs Academic Center n Campus t determine ptential specific field accmmdatins fr that dcumented disability befre the field placement prcess can prceed. Written specifics f thse ptential accmmdatins must be prvided t the Field Educatin Staff by Banacs Academic Center prir t yur field placement prcess. It is very useful t create a cllabrative prcess between the Field Department, the Banacs Academic Center and the student, particularly since pssible field placement sites will require clarity f reasnable accmmdatins that are being requested as part f the interview and decisin prcess. It is imprtant t nte that accmmdatins in the classrm may nt be accmmdated by a specific field placement agency. Als, if apprpriate, please prvide any infrmatin belw that yu believe might be helpful t us in lcating the best pssible field placement fr yu. Many field settings, particularly medical facilities, require students shw prf f immunizatins, health clearance frm a medical prfessinal and/r drug testing (the student is respnsible fr any assciated csts). D yu have any cncerns abut the ptential f these requirements? Yes N If yes, please explain r cntact yur assigned Field Educatin Staff t discuss further: All ptential field sites request infrmatin abut a student s prir wrk and vlunteer experience, a current resume, status within the scial wrk prgram (hw many years cmpleted, current GPA, curses taken, previus internships, etc.). While this infrmatin is very ften crucial t cnsideratin fr an interview, we will nly prvide this infrmatin with yur permissin. D we have yur permissin t prvide this infrmatin and/r send a cpy f the Revised Nvember, 2017
resume yu are including with this applicatin t a prspective placement representative? N (If n, please cntact yur assigned Field Educatin Staff t discuss this further). Yes NARRATIVE In narrative frm, please discuss three scial wrk related skills and strengths yu will bring t a placement, three scial wrk related skills yu will need t strengthen during yur field placement, and any additinal infrmatin yu feel is relevant as we cnsider yur field placement. Yur electrnic signature belw cnfirms the fllwing: I have read the Field Educatin Manual and understand that the infrmatin cntained in the manual, as well as the infrmatin in this field applicatin, represent the plicies, prcedures, and guidelines that I am required t fllw in regard t the field educatin prtin f my academic prgram f study. My respnses in this field applicatin are accurate and cmplete. I als understand that I am respnsible fr cntacting the Field Educatin Department if any f the infrmatin changes at any pint in the field educatin prcess and/r after I have begun my field placement. Type Full Name as Electrnic Signature: Date Signed: Revised Nvember, 2017