MSW Student Practicum Proposal Form

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Kerrie Benson
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Faculty of Social Work Southern Alberta Region SOWK 696: Advanced MSW Practicum MSW Student Practicum Proposal Form This form is to be completed by MSW students who are proposing to complete their

1 Faculty of Social Work Southern Alberta Region SOWK 696: Advanced MSW Practicum MSW Student Practicum Proposal Form This form is to be completed by MSW students who are proposing to complete their practicum in a community agency. This form must be signed by the MSW student, an Agency Delegate from the community agency, and the MSW Field Instructor indicating joint agreement to this proposal. This form is to be returned to the Field Coordinator whom will review this proposal for approval. Please attach additional pages as needed to complete this form. Summary of Advanced Practicum (SOWK 696) requirements: Total practicum hours for MSW course-based students 525 hours Days of week students are in placement: 2-5 days as negotiated (8 hours/day) Possible timeframes of placement: January August September April Field Instructor credentials: MSW, RSW and two years experience Supervision requirement: 1 hour direct supervision per 15 hours placement Integrative Seminar: up to 40 hours (counted toward practicum hours) Student Name UCID# Will your practicum be completed in your current place of employment? Yes No Practicum Timelines - when do you propose to start/finish your Practicum? Start Date Proposed Completion Date Days/hours per week

2 Name and address of Organization/Agency where you plan to do your Practicum: Focus/Services of Agency: Give a brief description of your proposed practicum including primary learning goals, learning opportunities, projects, and/or activities. Please identify several specific therapeutic modalities and theories you plan to study and practice during your practicum. How will this practicum meet your MSW Clinical Specialization learning needs and opportunities for clinical practice within your areas of interest? Who will provide supervision, how will supervision be provided, and what steps will be taken to support that a minimum of one hour of supervision for every 15 practicum hours will be provided (formal and informal)?

3 Describe how the field instructor and student will be provided with ample time to engage in learning activities, reflection, critical thinking and discussion. What time has been set aside for the student to engage in these processes? It is crucial that the student not be carrying a full caseload for the purposes of the practicum. Student Name Student Signature Agency Delegate Name Position Agency Agency Delegate Signature

4 Field Instructor Name Qualifications and Years of Experience Field Instructor Signature Additional Field Instructor External Field Instructor Field Instructor Name Qualifications and Years of Experience Field Instructor Signature MSW Practicum Approved Not Approved Date Signatures Comments

5 Comments Continued NOTE: ALL STUDENTS ENGAGED IN ALBERTA HEALTH SERVICES PRACTICUMS MUST MEET THE REQUIREMENTS AS OUTLINED IN THE LETTER OF AGREEMENT. Please return completed documents to Laurie Schaufert at University of Calgary, Faculty of Social Work, Southern Alberta Region, 4401 University Drive West, Lethbridge, AB T1K 3M4 or by at BEFORE commencement of the practicum. All required forms and information can be obtained from the website ucalgary.ca/fswsouth

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