MSW Field Application

MSW 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*

3-digit 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.*

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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.*

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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 and with at least 2 years of post-MSW practice experience to supervise them and then you must forward the agency name, the agency supervisor name, telephone number, and email address on your 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.*

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Advanced Standing Students only: Advanced standing students from institutions other than WNMU must provide written documentation that the student was required to complete a minimum of 450 hours within their BSW Field Practicum during the application process to Field. Students who did not meet the 450 hour requirement will be required to complete any additional hours necessary to achieve this requirement before continuing practicum hours at the MSW level.
Signature (Advanced Standing Students only)

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Application Acknowledgment & Submission
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
Advanced Standing Students only:

Browse Files
Upload a copy of evidence of 450 practicum hours at CSWE-accredited BSW level (e.g. signed time sheets; letter from field director, etc.) *Students matriculating from WNMU's BSW program are exempt from this requirement. Cancelof
Should be Empty:

	Grade of A	Grade of B	In Progress	Not applicable
SWK 501 (all)
SWK 502 (non-advanced)
SWK 510 (non-advanced)
SWK 511 (non-advanced)
SWK 527 (advanced only)

MSW Field Application

Applicant Information

Areas of Interest

Learning Patterns

Additional Information

Application Acknowledgment & Submission