UNIVERSITY AT ALBANY

SCHOOL OF SOCIAL WELFARE

APPLICATION FOR 2nd YEAR SUMMER/FALL FIELD

To be eligible for this field option, a student must meet the following requirements:

  • Satisfactorily completed Field Instruction I and II
  • Have completed advanced practice coursework prior to taking OR taking advanced practice coursework concurrently with field

Instructions:

The application is constructed as a Word document and text can be typed in or checked off in applicable sections. Completed applications must include a letter of recommendation from your previous field instructor, an up-to-date resumeanda list of your completed masters-level courses. You may submit a copy of the advisement worksheet to indicate completed and in progress course work.All applications should be submitted by the due date to the Field Education Office in Richardson 116.

NAME: STUDENT ID:

PHONE NUMBER: () EMAIL:

CURRENT CONCENTRATION:☐CLINICAL☐ MACRO

CURRENT OR FIRST FIELD PLACEMENT:

CURRENT OR FIRST FIELD INSTRUCTOR NAME:

Please describe prior employment in social welfare settings. Be specific about roles, populations served, length of time, etc. Attach a current up-to-date resume to this application, showing month/year and full or part-time employment.

Please state your short term career goals, e.g., next five years.

Please give a brief explanation of your reasons for applying for the Modified Field Option.

Please describe the type of advanced concentration field experience you are interested in and why. Address the following: how placement would relate to your career goals, types of activities or roles you envision, type of agency and client population, any additional, relevant and helpful information.

Information related to placement Location:

(If your answer is “no” to any of the following questions, please understand that your options may be limited)

Do you have a current driver’s license? ☐YES ☐NO

Do you have a car available to travel to and from field? ☐YES ☐ NO

Some agencies expect students to have a car available for

travel-related to the placement (not client transport).

Can you meet this expectation? ☐YES ☐NO

Disabilities:

Reasonable accommodations will be provided for students with a documented disability. Any disability that requires an accommodation in field requires a formal request for accommodation be made to the University at Albany’s Disabilities Resource Center in Campus Center-137 or (518) 442-5490 as soon as possible. Thereafter, the Field Office will work with students and field agencies in an effort to provide such accommodations. Below, please indicate if you will be requesting an accommodation in field as a result of reported disability that has been filed with the University at Albany’s Disabilities Resource Center. If not indicated, please write “N/A”.

By signing below, I assert that I am aware of the SSW Standards for Social Work Education. I understand that any information deemed important to the placement will be shared with the field instructor. If required for my placement, I agree to complete a criminal background check, child abuse registry and/or any health screenings (including drug testing, TB and Hepatitis-B test, etc.) necessary for the acceptance of my field placement. By declining an agency’s request for these required procedures, I am aware that my refusal will limit my placement options or lead to me not obtaining a field placement. I understand that a classification as a sexual offender will deem me ineligible for field.

Student’s Signature ______Date:______

ADVANCED CONCENTRATION SUMMER/FALL MODIFIED FIELD APPLICATION