DUE DATES
1ST FIELD – July 1
2nd FIELD – April 1
School of Social Welfare
State University of New York at Albany
FIELD EDUCATION OFFICE
WORK-STUDY APPLICATION
NAME:
STUDENT ID:
FIELD CONCENTRATION:
SEMESTERS:
☐ Fall
☐ Generalist
☐ Spring
☐ Clinical
☐ Summer
☐ Macro
ACADEMIC YEAR:
AGENCY NAME:
ADDRESS:
CITY:
STATE:
BUSINESS PHONE:
ZIP CODE:
PERSONAL PHONE:
In this section, describe the distinct differences between your primary employment and the
proposed Work Study placement:
CURRENT EMPLOYMENT
PROPOSED FIELD PLACEMENT
NAME OF PROGRAM
NAME OF PROGRAM
POPULATION SERVED
POPULATION SERVED
TYPE OF CLIENT SERVICES PROVIDED
TYPE OF CLIENT SERVICES PROVIDED
Work Study Application
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TREATMENT/SERVICE GOALS
TREATMENT/SERVICE GOALS
INTERVENTION METHODS
INTERVENTION METHODS
PHYSICAL SITE LOCATION
PHYSICAL SITE LOCATION
WORK SCHEDULE (DAYS AND TIMES)
FIELD SCHEDULE (DAYS AND TIMES)
SUPERVISOR NAME/TITLE/PHONE:
FIELD INSTRUCTOR
NAME/TITLE/PHONE:
Work Study Application
Page 2
By signing the Work Study application, the student and employment site agree to the terms of a
Work Study field placement in accordance with the academic standards for field by the
University at Albany School of Social Welfare. If needed, the Field Education Office is also
permitted to contact the student’s supervisor and proposed field instructor for additional
information related to the Work Study application.
SIGNATURES
_______________________________________
Student
______________________
Date
_______________________________________
Current Supervisor
______________________
Date
_______________________________________
Agency Authorizing Official
______________________
Title
______________________
Date
Attach to this application your resume, your proposed field instructor’s resume, a letter of
agreement from the proposed field instructor, and any other material you think would be
helpful in reviewing your Work Study proposal.
Work Study Application
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Work Study Applicant Analysis – Part I
The goal of Work Study is to allow qualified applicants the opportunity to complete a year
of field at their place of employment. Although this offers a measure of convenience for
students, a work study internship must first and foremost deliver the educational rigor
equivalent to a traditional internship at an outside agency. Work Study placements
present unique challenges, such as potential role confusion between learner and employee.
As a result, the Field Education Office carefully considers Work Study proposals to ensure
that the placement is designed to primarily serve the educational goals of field and
identifies measures that will safeguard the educational integrity of the field placement.
Please provide your well-considered full length answers to the following questions in the space
below.
What are your top four learning goals for this this placement and how will your proposed work
study plan assist me in achieving them?
Goal #1:
Goal #2:
Goal #3:
Goal #4:
Work Study Application
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Work Study Applicant Analysis – Part II
What safeguards have been built in to your proposal that will work to ensure that the following
aspects of your field learning will remain separate and distinct from your role as an employee?
1. Schedule:
2. Work Space:
3. Supervision:
4. Staff:
5. Clients Served:
Work Study Application
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University at Albany
State University of New York
School of Social Welfare
Office of Field Education
Statement of Completion
Work Study Application
I am submitting a completed work study application packet that includes:
☐
☐
☐
☐
☐
Application with sufficient signatures (applicant, applicant’s employment supervisor,
agency executive director)
Work Study Applicant Analysis
Applicant’s current resume
Proposed Field Instructor’s resume
Proposed Field Instructor’s letter of commitment
Signature __________________________________ Date _________________
Work Study Application
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