Date Received by Field Dept s1

Name Date Received by Field Dept

Social Work Program Application for Field Practicum

Directions: The field education process is a partnership involving the Social Work Program, the Field Education Director, social work faculty, field placement sites, field instructors, and social work students. Your mindful, thorough, completion of this application supports that process and allows us to move forward in developing a positive field placement. Providing this application late, not providing the requested information, and/or not communicating with and responding to the Field Education Director through the process will result in a delay in obtaining a field placement and may limit your available placement options.

. It is very important that you review the Field Education Manual prior to completing this application. This will help you to understand the specific requirements of your field placement and the field education process. The Manual is available on the Social Work Website Field Education Page and a hard copy is provided to each student at the beginning of the academic year. . Complete the application by computer. o Click the appropriate check box and/or type information in the expanding text box. . Provide an electronic copy of the completed application to the Field Education Director by the Due Date. o Be sure to save your completed application with your last name as part of the file name (i.e. “SmithFieldApp.docx”). . The application is only considered complete when an electronic copy of a current resume is also provided.

I am applying for: (check one answer) BSW Field Placement

MSW Foundation Year Placement

MSW Advanced Year Placement in the Traditional MSW Program

MSW Advanced Year Placement in the Advanced Standing MSW Program

My Contact Information: 1. Best Phone # To Contact Me: Does this Phone # Change during Semester Break or during the Summer Months? Yes No

If yes, please provide the best Phone # to reach you during those times: 2. My Address during the timeframe I will be complete my field placement:

Feb, 2013 Page 1 of 4 Street City 3. Email Address: Your Westfield State email address is considered to be your primary email address, both during the academic year and the summer. You are expected to check this email regularly as this will be the primary way the field department will communicate with you.

Section I: Field Placement Interests and Experience

1. Have you completed previous field placements? Yes No. If yes, please describe the nature of the placement(s), the aspects of the placement(s) you felt most useful and any aspects you felt were not helpful.

2. Are there specific client populations (i.e. children, older adults) or practice areas (i.e. addictions, child welfare, medical facilities, residential services, schools, etc.) you are particularly interested in? Please discuss your interest (including why these populations interest you) and any previous experience you have in any of these areas?

3. Please note that field placements are negotiated and finalized by the Field Education Department, not by students. If you have reason to believe that a specific agency/organization is available to you for a field placement, please provide that information here (including contacts) and we will contact the agency/person to discuss field placement requirements. We always welcome your ideas for new placement possibilities.

4. Are you considering completing your field placement at your place of employment? Yes No If, yes, please review the section in the Field Education Manual that discusses this type of placement. You will need to complete an Application for Employment-Based Field Practicum (available on the Social Work Website) in addition to this application. Your application will only be considered complete when both applications are received. As with all placements, the final approval for an Employment-Based Placement is made by the Field Education Director.

5. Are there specific client populations and/or practice areas you would feel uncomfortable working with? Please explain here or make an appointment to discuss further with the Field Education Director.

6. Do you have any particular skills or qualifications that may apply to specific client populations or practice areas (i.e. fluent in a language other than English, CPR training, licenses, etc)?

7. Please describe the three most significant strengths you believe you will bring to a field placement.

8. Please describe the three most significant areas you believe you will need to strengthen during your field placement.

Feb, 2013 Page 2 of 4 9. Are there any reasons you could not complete a field placement in a specific agency (i.e., have previously worked there and/or have relatives or friends that work there, receive(d) services there, etc.)? Please explain.

Section II: Availability

1. Do you have a valid driver’s license? Yes No

2. Will you have access to a car for travel to and from your field placement? Yes No

3. If you answered “No” to questions 1 and/or 2, how will you travel to and from your field placement?

4. Please review the Field Education Manual for the specific hours required for your field placement. Generally, placements begin in September and end in May of the following year, with an overall requirement of either 400 or 500 hours. The majority of field sites require that students are available during daytime hours, Monday through Friday. The few sites that do offer evening and/or weekend hours may still require that students are available to attend trainings, team meetings, supervision, etc., during daytime hours. Most students find it is easier (and most sites strongly prefer) to set aside two or three days with longer timeframes instead of trying to work only a few hours over several days. Please list your anticipated availability below:

Monday Tuesday Wednesday Thursday Friday Sat/Sun

5. Please explain any other commitments that may affect your availability for your field placement.

Section III: Other Relevant Information

Many agencies/organizations have additional requirements in considering students for field placements. The following information will help us to select appropriate placements:

1. Have you ever been convicted of a crime (misdemeanor and/or felony) and/or have a negative CORI in Massachusetts or any other state? Yes No. If yes, you will be required to provide a copy of the most recent CORI to the Field Education Director prior to being considered for field placement. Many agencies with also require that you allow the agency to run a current CORI before approval for a placement. Also, please provide additional details here (date and type of conviction, disposition or sentence, dates of probation, etc.) or contact the Field Education Director to discuss this further.

Feb, 2013 Page 3 of 4 2. Are you currently, or have you ever been, a client with the Department of Children and Families (DCF, formerly the Department of Social Services, DSS) in Massachusetts or any other state? Yes No If yes, please provide additional details here or contact the Field Education Director to discuss this further.

3. Do you have a documented disability that might lead you to make a request for reasonable accommodations within a field placement? Yes No. If, yes, you may want to contact the Banacos Academic Center on Campus to learn more about supportive services that may be available to you. It is very often helpful to create a collaborative process between the Field Department, the Banacos Academic Center, and the student. Most possible field placement sites will request clarity of reasonable accommodations that are being requested as part of the interview process. Also, if appropriate, please provide any information below that you believe might be helpful to us in locating the best possible field placement for you.

4. Many field settings, particularly medical facilities, require students show proof of immunizations and a health clearance from a medical professional (the student is responsible for any associated costs). Do you have any concerns about the potential of these requirements? Yes No. If, yes, please provide additional details here or contact the Field Education Director to discuss this further.

5. Many potential field sites request information about a student’s prior work experience, a current resume, status within the social work program (how many years completed, current GPA, courses taken, previous internships, etc). While this information is very often crucial to consideration for an interview, we will only provide this information with your permission. Do we have your permission to provide this information and/or send a copy of the resume you are including with this application to a prospective placement representative? Yes No. If, not, please contact the Field Education Director to discuss this further.

6. Do you have any additional information, suggestions, or requests that you feel are relevant as we consider your field placement?

Contact Information for the Field Education Director: Terri J. Haven, MSW, LICSW 413-572-8405 [email protected]

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