FOUNDATION FIELD PRACTICUM PLANNING GUIDE
I.
STUDENT INFORMATION
Date: ______________ (Format: mm/dd/yyyy)
Name: ______________________________________
Local Information:
Address: _______________________________________________________________
City: ____________________
State: ______________
Zip Code: __________
Daytime Phone: ____________________ Evening Phone: ______________________
Email Address: __________________________________________________________
Summer Information (if different):
Address: _______________________________________________________________
City: ____________________
State: ______________
Zip Code: __________
Daytime Phone: ____________________ Evening Phone: ______________________
Email Address: __________________________________________________________
Program Location:
___ Chapel Hill ___ Triangle ___ Winston Salem
I am requesting a:
____
Concurrent placement for Fall/Spring (Concurrent placements are the standard field
arrangement for students at the School. Students must demonstrate a compelling reason for an
exception.)
____
Ad Hoc or Block Placement (Review the policies on Ad Hoc and Block Placements in the Field
Education Manual; complete the appropriate Ad Hoc Placement Proposal or Block Placement
Proposal, and submit the request to the Director of Field Education.)
____
Placement in my employing agency (Review the policy on Placement in an Employing Agency in
the Field Education Manual, complete the appropriate Employer Based Placement Proposal, and
submit the request to the Director of Field Education.)
Student Status:
____ MSW
_____ MSW/PhD
____ Dual Degree; please specify which program: __________________
Have you been accepted to the dual degree program?
 Yes
 No
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FOUNDATION FIELD PRACTICUM PLANNING GUIDE
Experience:
Years of social work related employment experience:
_________ full-time
_________ part-time (approximate hours per week)
Years of other employment experience _________
Years of social work related volunteer experience __________
How frequently did you volunteer? ______________________________
II.
PLACEMENT INTERESTS
The Foundation practicum provides the student with opportunities to develop generalist social
work knowledge and skills and to apply fundamental social work values and ethics in a practice
setting. Foundation placements in selected community agencies allow students to develop core
social work competencies by applying a range of prevention and intervention strategies, in
direct practice with individuals, families or groups, and also with organizations and
communities. To the extent possible, within the context of the Foundation Goals and Objectives,
we incorporate your social work interests in the placement process. Students do not specialize
in methods or fields of practice in the Foundation practicum.
A.
What do you imagine yourself doing, as a professional social worker, one year after graduation?
Five years after graduation?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
B.
What client populations interest you the most? (For example, older adults, children,
adolescents, individuals with mental illness, persons with disabilities, etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
C.
What social problems are most interesting to you? (for example poverty, child abuse, domestic
violence, homelessness, immigration, etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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FOUNDATION FIELD PRACTICUM PLANNING GUIDE
Please check practice areas you would consider for your placement (check all that apply):
 Children and their families
 Child Welfare
 Adults and their families
 School Social Work
 Family Violence
 Substance Abuse
 Mental Illness
 Health Care
 Aging
III.
SPECIAL CONSIDERATIONS
Language Skills:
Do you speak another language other than English?
 Yes
 No
If yes, please specify which language(s) and indicate proficiency below:___________________________
___ fluent (equivalent to a native speaker)
___ proficient (able to use the language accurately on a professional level)
___ conversant (able to participate in practical, social, informal conversations and limited professional topics)
___ limited (can satisfy minimum routine requests and courtesies)
Conditions of Scholarship or Stipend:
If you receive a stipend or scholarship, are there any conditions that may restrict your placement? If yes,
please explain:
_____________________________________________________________________________________
_____________________________________________________________________________________
Additional Considerations:
The Field Education Program makes every effort to provide each student with the best placement match
possible according to the student’s individual needs and goals. If there are other factors that we should
consider as we plan your foundation placement assignment (e.g. race, religion, criminal history, culture,
sexual orientation, gender expression, health concerns, learning needs, other special needs or
considerations), please explain below. If you prefer to speak to someone directly about your individual
needs, please plan to discuss this with the field faculty member that is assigned to you during the field
education planning process.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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FOUNDATION FIELD PRACTICUM PLANNING GUIDE
Students with documented disabilities are asked to contact the University Department of Disabilities
Services to receive support and assistance with any accommodations necessary to enhance their
learning. The Field Education Office strongly encourages students to be open with their Field Advisor
and potential Field Instructor in terms of special circumstances as this will assist in the selection of your
field placement site and the development of learning activities that best meet your individual needs.
UNIVERSITY POLICY ON NONDISCRIMINATION
The University is committed to providing an inclusive and welcoming environment for all
members of our community and to ensuring that educational and employment decisions are
based on individuals’ abilities and qualifications. Consistent with this principle and applicable
laws, it is therefore the University’s policy not to discriminate in offering access to its
educational programs and activities or with respect to employment terms and conditions on
the basis of age, gender, race, color, national origin, religion, creed, disability, veteran’s status,
or sexual orientation, gender identity or gender expression. Such a policy ensures that only
relevant factors are considered and that equitable and consistent standards of conduct and
performance are applied (see www.unc.edu/campus/policies/nondiscrim.html).
IV.
COURSE INFORMATION – DISTANCE EDUCATION STUDENTS ONLY
If you are a Distance Education student, complete this form. List social work
courses exempted, completed, and those in progress. Please indicate when the
course was taken.
Course Number
SoWo 500
SoWo 501
SoWo 505
SoWo 530
Course Title
Semester/Year Taken
Human Development in Context: Infancy to
Adolescence
__________________
Confronting Oppression and Institutional
Discrimination
__________________
Human Development in Context: Adulthood
to Older Adulthood
__________________
Foundations of Social Welfare and Social
Work
__________________
List other relevant courses:
Course Number
Course Title
Semester/Year Taken
_____________
________________________________
_________________
_____________
________________________________
_________________
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FOUNDATION FIELD PRACTICUM PLANNING GUIDE
V.
STUDENT PERMISSION & SIGNATURE
Does the field office have your permission to share all of the information in this Planning Guide and your
résumé with potential Field Instructors? If you have concerns about releasing this information please
discuss them with the Field Office.
Yes
 No
Thank you for completing the Foundation Planning Guide
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FOUNDATION FIELD PRACTICUM PLANNING GUIDE
RESUME GUIDE
Your resume is your field instructor’s first introduction to you. It will give you the
opportunity to share information about yourself in a brief, easy to read style and it
should be done with great care. Below is one way your resume can be arranged. While
it is not necessary for you to arrange yours in this manner, it is necessary that you
include the information listed.
Limit your resume to two pages or less.
A.
Personal data
Name, address, phone, email address
B.
Education experience
Educational institutions and the dates you attended. List degrees, majors and
minors.
C.
Work/Volunteer experience
List your work and volunteer experience in chronological order. Provide a brief
(2-3 lines) job description with beginning and ending dates. Identify paid
positions. Also identify those positions in which you had MSW supervision.
D.
Special skills or attributes
In this section, list those skills or attributes that enhance your ability to work
with others. For example: do you speak a foreign language or are skilled in sign
language? Are you skilled in athletics, art, music, or public speaking? Do you
have extensive skill in computer technology?
E.
Professional affiliations, certifications or licensures, and honors
In this section, list membership in professional organizations such as NASW,
CSWE, etc. Also indicate licensure or certification in specific related areas. Any
specific academic or community honors would also be appropriate here.
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