CONCENTRATION FIELD PRACTICUM PLANNING GUIDE
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 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.)
Concentration:
____ Direct Practice
____ Community, Management and Policy Practice
____ Self-Directed
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CONCENTRATION FIELD PRACTICUM PLANNING GUIDE
List social work courses, completed, exempted and those in progress. Please indicate when the course was taken.
Course Number
SoWo 500
SoWo 501
SoWo 505
Course Title
Human Development in Context: Infancy to
Adolescence
Confronting Oppression and Institutional
Discrimination
Human Development in Context: Adulthood to
Older Adulthood
Semester/Year Taken
SoWo 510
SoWo 517
SoWo 530
SoWo 540
Foundations for Evidence-Based Practice and
Program Evaluation
Integrated Practice
Foundations of Social Welfare and Social Work
Social Work Practice with Individuals, Families and Groups
SoWo 570
SoWo 523
SoWo 524
Social Work Practice with Organizations and
Communities
Foundation Field Seminar
Foundation Field Seminar
List other relevant courses:
Course Number
_____________
Course Title
________________________________
_____________
_____________
________________________________
________________________________
III.
A.
Semester/Year Taken
_________________
_________________
_________________
Identify your specific learning objectives for your Concentration year of field instruction.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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CONCENTRATION FIELD PRACTICUM PLANNING GUIDE
B.
Describe activities and assignments which you believe will help you achieve these objectives:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
C.
D.
What do you imagine yourself doing, as a professional social worker, one year after graduation?
Five years after graduation?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What supervisory style is the best fit with your approach to learning?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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 concentration 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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CONCENTRATION 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).
Does the field office have your permission to share all of the information in this Planning Guide and your resumé with potential Field Instructors?
If you have concerns about releasing this information please discuss them with the Field Office.
 Yes
 No
Identify three (3) different, preferred placements; list them in order of preference. (NOTE: Three different field instructors in the same agency/unit constitute ONE choice). Contact the Field Education
Office if you have difficulty identifying three choices.
1.
_________________________________________________________________
2.
_________________________________________________________________
3.
_________________________________________________________________
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