Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215

Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215

Field Education Department (617) 353-3754

CHARLES RIVER CAMPUS - Foundation (First) Placement Form

This form will be used to plan your field experience. Please complete and email this form along with a current resume to .

Name:

E-mail Student Terrier Card #: U

Present address: city/state zip

Phone #s: home work cell

Summer address: city/state zip

Anticipated address for the coming year:

Education –

Undergraduate/Graduate School Degree Date Major

Will you have access to a car for your placement? Yes No

If you can practice professionally in any language(s) other than English, please specify language(s)

Please specify the METHOD CONCENTRATION which you are currently considering (check all that apply):

CLINICAL: Individuals Families Groups

MACRO: Community Organizing Management Planning

Have you already been accepted to or enrolled in a dual-degree program:

Public Health Education Theology

Please answer the following questions:

1. Birthdate (optional)

2. Gender identity (optional)

3. Do you wish to identify ethnically/racially/culturally? If so please indicate:

The next few questions address your educational interests and career goals. Your answers will help us identify a foundation field placement that will build on your previous experience, introduce you to new populations and fields of practice, and support your professional goals. Please keep in mind that the foundation placement is designed to expose you to both clinical and macro practice. In order for us to make thoughtful assignments, it is essential that we have an electronic copy of your resume in addition to this form.

4. Please briefly describe your social work career goals, including social work method (Clinical,

Macro, or both, if known), population, social problem focus, etc.:

5.  We recommend that you save your area of specialization for your advanced (2nd) placement.

Please describe the types of settings that would introduce you to new populations and/or social

problems for the foundation (1st) placement:

6. If there is any additional information about you or your background that would be helpful for

us to have in making your assignment, please comment: