Student Name: Application for Employment-Based Field Practicum. DEPARTMENT of SOCIAL WORK

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1 DEPARTMENT f SOCIAL WORK Student Name: Applicatin fr Emplyment-Based Field Practicum Directins: The field educatin prcess is a partnership invlving the scial wrk prgram, field educatin Prgram, 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 applicatins and/r d nt actively cllabrate with field educatin staff will risk delayed entrance int the field and subsequent delay in cmpleting field requirements. It is essential that yu review the Field Educatin Manual prir t cmpleting this applicatin t mre fully 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: Cmplete this applicatin prcess electrnically, if at all pssible. Since this applicatin requires infrmatin frm third parties (ptential and current supervisrs/managers, etc), the applicatin will als be accepted by scan, fax, r hard cpy. Click the apprpriate check bxes and/r type infrmatin in the expanding text bxes. If electrnic (strngly preferred), please be sure t save yur cmpleted applicatin with yur last name as part f the file name and in the fllwing PDF frmat (last name,first name,fieldapp (i.e. Smith,Jane,FieldApp.pdf ). Prvide an electrnic cpy f the cmpleted applicatin by the Due Date t: Linda Silk, Assistant t the Field Educatin Prgram at: lsilk@westfield.ma.edu. If faxed, send t the attentin f the Field Educatin Prgram at May be delivered in persn t the Scial Wrk Department at Md Hall n Campus during nrmal business hurs. The Emplyment Based applicatin is nly cnsidered cmplete when accmpanied by the Applicatin fr Field Practicum. Page 1 f 5

2 I am applying fr: (check ne answer) BSW Field Placement MSW Fundatin Year Placement MSW Advanced Year Placement in the Traditinal MSW Prgram MSW Advanced Year Placement in the Advanced Standing MSW Prgram I am currently enrlled in: BSW Prgram 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 Emplyment-based Field Placement Requirements In sme situatins, a field placement can be established within the student s place f emplyment. An emplyment-based placement requires a new and separate set f respnsibilities within the emplyment setting. Students cannt receive field placement credit fr current r past wrk experience. In additin t the plicies and prcedures utlined in the WSU Field Manual, an emplyment-based placement must meet the fllwing criteria t be apprved: 1. The student/emplyee has been emplyed at the rganizatin fr a minimum f 3 mnths prir t applying fr an emplyment-based field placement. 2. The student s place f emplyment must allw the student/emplyee t attend required classes. 3. The field placement must prvide a placement experience a. in an area, prgram, r service different frm the ne where the student is currently emplyed, has been emplyed, r has had a previus field placement. b. that includes new learning pprtunities (i.e., the pprtunity t wrk with at least sme f the fllwing: different client ppulatins, different interventin methds, different plicies and prcedures, different cmmunity interfaces, different agency staff, etc.). 4. The student s place f emplyment must prvide a Field Instructr wh meets the fllwing requirements: a. has been emplyed by the rganizatin fr at least ne year, b. has a minimum f tw years f pst-degree scial wrk experience, as applicable c. is nt the student s current supervisr in his/her jb. Page 2 f 5

3 Fr BSW Students, the Field Instructr must als: a. have a Bachelrs r Masters degree in Scial Wrk (BSW r MSW) frm a CSWE accredited prgram. Fr MSW Students, the Field Instructr must als: a. have a Masters (MSW) degree in Scial Wrk frm a CSWE accredited prgram. b. Massachusetts State Regulatins als require that field instructrs hld a license t practice scial wrk in the Cmmnwealth f Massachusetts as a Licensed Independent Clinical Scial Wrker (LICSW) r Licensed Certified Scial Wrker (LCSW) r be exempt frm such license (if emplyed by the Cmmnwealth f Massachusetts and exempt r emplyed ut f state). WSU prefers that field instructrs f students in an advanced year placement have an LICSW (r be eligible fr such license r the equivalent in anther state). The assigned Field Instructr must agree t directly prvide the student with a minimum f ne hur/week f individual supervisin and must als ensure that the student will receive at least ne additinal hur/week f grup supervisin and/r task-riented supervisin (may r may nt be prvided by the primary Field Instructr). If the supervisr has nt previusly supervised scial wrk students, the rganizatin must allw the Field Instructr t participate in a field rientatin meeting and in Supervisin in Field Instructin (SIFI) training, as required by the Westfield State University Department f Scial Wrk. SIFI training cmpleted at anther accredited MSW prgram may be accepted if it meets Westfield State University Prgram requirements fr Field Instructr training. Cnsideratin will be given t individual circumstances and/r prir supervisr experience that may warrant either alternative methds f ensuring field instructr training and cmpetence r waiving f the SIFI requirement. 5. The field agency must establish a frmal affiliatin agreement with the Westfield State University Department f Scial Wrk. Emplyment-Based Field Placement Specific Prpsal Place f Emplyment Address Student s Current Psitin as Emplyee Length f Time in Current Psitin Descriptin f Current Duties Current Wrk Schedule Current # f Weekly Wrk Hurs Current Supervisr Prpsed Field Placement Psitin Page 3 f 5

4 Nte: Prpsed Emplyment-Based Placement must meet all requirements as detailed in the WSU Field Manual fr the particular year f placement (BSW, MSW Fundatin, r MSW Advanced) Detailed Descriptin f Prpsed Duties Prpsed Placement Schedule Prpsed # f Weekly Placement Hurs Discuss Differences Between Emplyee Psitin & Field Placement (i.e., differentiatin in departments, clients, etc) Will current respnsibilities and/r wrk hurs be adjusted t accmmdate the field placement (i.e. reduced caselad, reduced hurs, etc.)? Yes N Please discuss: Prpsed Scial Wrk Field Instructr Cntact Inf (phne #, ) Length f Time at Emplyment Site Institutin/Date f Scial Wrk Degree Years Pst-degree Experience (attach resume) Licensure Inf (attach cpy f license) Previus Experience as Field Instructr N Yes (where, when) Cmpleted SIFI N Yes (where, when, include cpy f cert) Signatures belw indicate agreement t the Emplyment-based Field Placement Requirements and Specific Prpsal listed in the abve dcument. Please nte that the prpsal is nly apprved as an emplyment- Page 4 f 5

5 based field placement when signed by the student, required emplyer representatives, and WSU Field Educatin Directr. WSU Field Educatin Directr may request additinal infrmatin and/r site visit in cnsideratin f this applicatin. Electrnic/scanned signatures and dcuments are accepted if prpsal is submitted by r fax. Hwever, an riginal signed cntract will be required fr the student s WSU recrd. Student Signature/Date Current Emplyment Supervisr Signature/Date Prpsed Field Instructr Signature/Date Emplyment Representative at Manager Level r Abve Signature/Date WSU Field Educatin Directr Signature/Date Page 5 f 5