The University of Northern Iowa

Department of Social Work

Departmental Application for Admission

Supplementary Application for Admission

Master of Social Work Program

I.Personal Data

Ms.

Mr.______

Last NameFirst NameMiddle/Maiden

Current Address______

Street City State or Country ZIP

Home Telephone: _____/______Current address active until______

Work Telephone: _____/______

*E-mail address:______

*It is essential that you list an email you check regularly. The link to complete the personal statement will be sent to this address.

  1. Resumé:

Include a copy of your resumé. To include all experience, both work- and volunteer-related, it may be necessary for your resumé to exceed one page in length.

III.Experience Narrative

In two to three double-spaced pages, provide a description of paid, volunteer, practicum and life experience relevant to social work and how those experiences have influenced your decision to pursue a career in social work at the master’s level. Include a description of any experience relevant to working with diverse populations, as well as any experience you have had working with populations that are oppressed, impoverished, marginalized, or alienated because of difference. Discuss your current career interests and goals.

IV.Personal Statement

Once your application is received, an email will be generated that provides a link to complete the personal statement. The email will be sent to the address you provided above.

V.Enrollment and Concentration Options

Please select the appropriate enrollment options and concentrations below:

Advanced Standing (your choices commit you to the concentration you selected if admitted).

Full-Time (three-term)

Social Administration (SA) only

Trauma Informed Practice (TI) only

If you wish to be considered for both concentrations, please indicate your preference rank.

First Choice ______

Second Choice ______

Extended-Enrollment (three-year/nine-term)

Social Administration (SA) only

Trauma Informed Practice (TI) only

If you wish to be considered for both concentrations, please indicate your preference rank.

First Choice ______

Second Choice ______

Two-Year, Foundation (your choices do not commit you to the concentration you selected if admitted).

Full-Time (five-term)

Social Administration (SA) only

Trauma Informed Practice (TI) only

Extended-Enrollment (four-year/eleven-term)

Social Administration (SA) only

Trauma Informed Practice (TI) only

  1. Statistics

Have you taken a statistics course? Yes No

If Yes, list statistics courses you have taken: ______

Grade received: ______

VII.Have you ever been convicted of a felony? Yes No

If you answered yes to this question, please provide relevant dates, the nature of the offense, the name and location of the court, sentence imposed and any other information you would want the Admissions Committee to consider.

Note: A felony conviction may prevent you from obtaining a license to practice Social Work in the State of Iowa or elsewhere. The State of Iowa requires social workers at the MSW level to hold a state license in order to practice within the state.

VIII.Have you been listed on a sex offenderregistry?

Yes No

If you answered yes to this question, please provide any other information you would like the Admissions Committee to consider on a separate sheet of paper.

Note: Listing on a sex offenderregistry may be a disqualification for some social work positions.

Application material is considered confidential. It is shared only with those persons concerned with your admission and your educational experience. The Department of Social Work reserves the right to investigate the accuracy of the information and to deny admission for reasons pertaining to an applicant's potential as a social worker.

I understand that any misrepresentation or omission of facts is sufficient cause to deny admission or, if enrolled, for termination from the program. I authorize the Department of Social Work, the University and its agents, to verify any information on this application, including conducting background checks into the records of law enforcement agencies and/or Bureau of Motor Vehicles for records of criminal convictions, as well as employer or reference checks.

I certify that all of the information contained in this application is true: I AgreeI Disagree

Students admitted to the M.S.W. Program are expected to abide by the National Association of Social Workers (NASW) Code of Ethics, the Iowa Administrative Code (645 IAC 282), and the UNI Student Conduct Code (Section 3.02). Violations will result in disciplinary action up to, and including, dismissal from the program. By signing below, I agree to adhere to the ethical values set forth by the NASW Code of Ethics.

Signature of applicationDate

UNI encourages and gives full consideration to all applicants for admission, financial aid, and employment. The University does not discriminate in access to, or treatment or employment in, its programs and activities on the basis of race, color, age, religion, sex, sexual orientation, national origin, veteran status, or disability. Inquiries about compliance should be addressed to the Office of Compliance and Equity Management.

This information is requested for the purpose of initiating the MSW application process. Directory information may be released to third parties but persons outside the University of Northern Iowa are not routinely provided with application material information. All items are required and therefore incomplete forms cannot be processed. (Pursuant to Chapter 22, Code of Iowa)