BSW Field Application

BSW Field Application
Applicant Information
Name*

First NameLast Name
W#*
WNMU Student ID
WNMU Email*
example@wnmu.edu
Secondary (non-WNMU) Email*
example@example.com
Select your course*
Semester Requested*
Year*
Cell Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Additional Information
Most work in your field placement will occur during normal business hours. However, some placements require evenings and/or weekend work. Please note that non-traditional hours (hours outside of normal business hours) may not be available in your area.
Please indicate that you understand the statement above.*

Clear
NOTICE: students requesting accommodations in field placement due to special needs, please contact Disability Support Services directly at (575) 538-6400 or by email: dss@wnmu.edu (the school cannot be held responsible for requested accommodations without documentation from the office of Disability Support Services prior to the field placement agreement)
Please indicate that you understand the statement above.*

Clear
WNMU School of Social Work is committed to ensuring a high quality field practicum experience for all of its students; however, students may not always be placed in their most desired agency. Students are responsible for finding their own agency that has an MSW or LCSW who is employed with the agency, with at least 2 years of post-MSW practice experience, to supervise them and then you must submit the agency name, the agency supervisor name, telephone number, and email address on the Agency Information Form, to your Field Internship Coordinator, so we can proceed with obtaining the agency paperwork. You must also follow up on agency paperwork to ensure that it is completed and returned.
Please indicate that you understand the statement above.*

Clear
If you do not understand or accept any portion of this application, please discuss your concerns with the Field Director.

My signature below indicates my understanding and acceptance of the contents of the Field Placement Application.
Signature*

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Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

Rows	Grade of A	Grade of B	Grade of C	In Progress
SOWK 2110
SOWK 1110
SWK 302 or 342
SWK 320
SWK 386
SWK 398

BSW Field Application

Areas of Interest

Learning Patterns

Additional Information