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Department of Social Work

Bachelor of Science in Social Work Program

SOWK 315 Junior Field Experience

STUDENT APPLICATION

FOR Term/Year: __ Fall 2014 (15 weeks); __ Spring 2015 (15 weeks)

__ Summer 2015 (10 weeks); __ Fall 2015 (15 weeks)

Please provide complete information and thoughtful responses to each item. As a student in a professional major, you will begin to develop a professional file and you will keep a copy of this completed application in your professional files. PLEASE DOWNLOAD AND TYPE IF POSSIBLE.

Date: ______

NAME: ______Tech. ID______

Address: ______Telephone # ______

Email: ______Cell #: ______

Overall GPA: ______SOWK Advisor: ______

Number of completed credits:______Number of credits current term: ______

Expected Term/Year of Graduation: ______

COURSE PREPARATION: Include all SOWK and Foundation courses completed, in progress (IP), and planned. Transfer students can include substituted courses. For “Term Planned” indicate term (summer, fall, spring) and year you plan to take the course.

SOWK COURSE / GRADE / IN PROGRESS / TERM PLANNED
SOWK 190W or 180W
SOWK 210 or 212
SOWK 214 (if required)
SOWK 305 or 310
FOUNDATION COURSE / GRADE / IN PROGRESS / TERM PLANNED
HUMAN DEVELOPMENT:
KSP 235
HUMAN DIVERSITY A:
HUMAN DIVERSITY B:
BIOLOGY:
STATISTICAL METHODS:
SOCIAL/ECON/POL PERS:
1.
2.
VALUES/ETHICS/CRIT-THINKING:

RELATED EXPERIENCES: Describe previous social service related experiences (volunteer or paid) you have had. Include the name of the organization, period of time spent in this activity, and the primary duties and responsibilities of your position.

SPECIAL SKILLS OR TRAINING: List any special skills, training, certifications, or licenses you possess which might be useful in a Field Experience.

OTHER WORK EXPERIENCE: Include part time or full time, beginning with the most recent

Employer / Job/Position / Dates: Begin-End

SELF-APPRAISAL: Provide a brief self-appraisal of your strengths, weaknesses, and personal characteristics, providing examples from your experiences

EXPECTATIONS OF FIELD EXPERIENCE: Describe what you expect to gain/learn from this Field Experience

The following information will assist us in working with you toward the location and selection of an appropriate Junior Field Experience setting.

AREAS OF INTEREST: Check all areas to consider for Junior Field Experiences.

Students are expected to do something different than previous experience or plans for future internships.

____ Aging____ Adolescents____ Chemical Dependency

____ Community Outreach____ Corrections____ Developmental Disability

____ Employment/Training___ Ethnic/Cultural Diversity____ Families/Children

____ Health Related___ Mental Illness____ Refugee Services

____ Other, please specify ______

Preferred geographic location for Field Experience:

______

Any preferred type of agency (school, county, etc)

______

Agency or agencies you plan to contact:

Agency Name / Agency Location

______

Student Signature (required)Date

I have reviewed this application with the above named student and support her/his plan to pursue a Junior Field Experience placement.

______

Faculty Advisor Signature (required)Date

Updated 6/14 LS