Return This Form Along with Your Resume to Meghan Trowbridge

Center for Disability Resources – Social Work Field Placement Application

Please print or type and provide all requested information. Return this form along with your resume to Meghan Trowbridge. Director of Training & Community Development Center for Disability Resources USC/SOM/PEDS Columbia, SC 29208 Phone: 803.935.5634 Fax: 803-935-5059 Email: [email protected]

Please note that to be considered for an internship, disability specific knowledge is not required; only inquisitive and open minds.

Date: ______

Name: ______

Local Address: ______

Phone Number: ______

Email Address: ______

Overall GPA: ______(undergraduate or graduate)

Are you applying for: ____ Undergraduate Field Placement ____ Graduate Field Placement

Area of concentration: ____ BSW ____ MSW ____ MSW/MPH

Please check appropriate year of field placement: _____ 1st Year ____ 2nd Year

If you are a 2nd year social work student at USC, are you a macro or micro student?

If you are a public health student at USC, which academic department are you taking classes from (i.e., Exercise Science, Epidemiology, HSPM, HPEB, etc.)? ______Short Answer Questions 1. What are your personal objectives for this internship?

2. What specific skills do you hope to develop through your field placement/internship with CDR?

3. What marketable skills or strengths do you currently possess?

4. A brief statement of your career goals and an explanation of how you would like this internship to help you reach those goals.

5. What personal expectations do you have for yourself while interning?

6. What expectations do you have for the Center for Disability Resources?

7. If you have any experience with people with disabilities, please share. (NOTE: this is NOT a requirement for field placement at CDR)