Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215
Field Education Department (617) 353-3754 sswfed@bu.edu
CHARLES RIVER CAMPUS - Advanced Standing Placement Form
This form will be used to plan your field experience. Please complete and email this form along with a current
resume to sswfed@bu.edu.
Please indicate your anticipated status in the program:
FULL-TIME
PART-TIME
Name:
E-mail
Student Terrier Card #: U
Present address
city/state
Phone #s: home
work
Summer address:
zip
cell
city/state
zip
Anticipated address for the coming year:
Education - School
Degree
Date
Major
Relevant work experience –
Agency
Position
Date
Paid or Volunteer
BSW senior year placement:
Will you have access to a car for your placement? Yes
No
If you can practice professionally in any language(s) other than English, please specify language(s)
Please specify your METHOD CONCENTRATION and specialization:
CLINICAL:
Individuals
Families
Groups
MACRO:
Community Organizing
Management
Planning
Please specify MACRO minor (if applicable): Yes
No
BOSTON UNIVERSITY SCHOOL OF SOCIAL WORK
FIELD EDUCATION DEPARTMENT
EDUCATIONAL ASSESSMENT
(to be completed by the student)
Student's Name:
Please complete the following assessment.
1.
Educational and Professional Background (include discussion of work and volunteer experience
and previous areas of study).
What relevant knowledge and skills do you bring from these experiences?
2.
Learning Style:
a) Describe your characteristic learning style:
b)
Comment on your level of independence in learning situations:
c)
What type of setting would be best for you (e.g. large or small, multi-disciplinary or all
social work, primary or host)?
d)
What information would be helpful to a potential field instructor to support your learning?
BOSTON UNIVERSITY SCHOOL OF SOCIAL WORK
FIELD EDUCATION DEPARTMENT
EDUCATIONAL ASSESSMENT (Continued)
3.
4.
Learning Needs and Goals
a) Have you defined a career path or goal?
Please describe briefly:
No
b)
What knowledge and skills do you want/need to acquire in this placement?
c)
Are there particular populations, modalities or social problem areas on which you want
to focus?
d)
Are there particular populations or modalities on which you should not focus? If yes,
please explain:
Learning Issues
a) Describe any learning problems you had in your undergraduate placements or academic
program.
b)
5.
Yes
How were these problems resolved and how might they impact the advanced placement?
Other
Please describe other factors which might play a role in your placement (include day and
time constraints, physical or geographic considerations).
UNDERGRADUATE FIELD PLACEMENTS
Please specify how many undergraduate field placements you had:
(or two), please provide the following information:
For the most recent one
PLACEMENT #1
a.
Agency:
b.
c.
Field instructor (agency supervisor)
Phone #(
Did your field instructor have an MSW? Yes
No
)
d.
How many hours of weekly individual MSW supervision did you receive?
How many hours of other weekly supervision did you receive? group
peer
other (specify)
e.
This field placement was done during my
f.
Total number of hours in field placement
g.
Number of hours/week in field placement
h.
Field placement was
i.
I wrote
process recordings or macro process analyses per week or if not weekly,
per semester.
j.
The process recordings/analyses were reviewed by
agency field instructor
school advisor/field liaison
school field coordinator
k.
My process recordings/analyses were reviewed weekly in supervision with my agency field
instructor:
Yes
No
l.
Did you have a written learning contract? Yes
m.
Please describe briefly your agency assignment(s) e.g. cases, groups, macro projects and the
nature of your interventions with them:
n.
Did your agency field instructor write a midyear evaluation?
Did your agency field instructor write a final evaluation?
Did you participate in the process?
one semester
sophomore
two semesters
junior
individual
senior year
block (describe)
No
Yes
Yes
Yes
No
No
No
UNDERGRADUATE FIELD PLACEMENTS (continued)
PLACEMENT #2
a.
Agency:
b.
Field instructor (agency supervisor)
c.
Did your field instructor have an MSW? Yes
d.
How many hours of weekly individual MSW supervision did you receive?
Phone #(
)
No
How many hours of other weekly supervision did you receive? group
peer
individual
other (specify)
e.
This field placement was done during my
f.
Total number of hours in field placement
g.
Number of hours/week in field placement
h.
Field placement was
i.
I wrote
j.
The process recordings/analyses were reviewed by
agency field instructor
school advisor/field liaison
school field coordinator
k.
My process recordings/analyses were reviewed weekly in supervision with my agency field instructor:
Yes
No
l.
Did you have a written learning contract? Yes
m.
Please describe briefly your agency assignment(s) e.g. cases, groups, macro projects and the
one semester
sophomore
two semesters
junior
senior year
block (describe)
process recordings or macro process analyses per week or if not weekly,
No
nature of your interventions with them:
n.
Did your agency field instructor write a midyear evaluation?
Did your agency field instructor write a final evaluation?
Did you participate in the process?
Yes
Yes
Yes
No
No
No
per sem
Please answer the following questions:
(Optional)
1.
2.
3.
Birthdate
Gender Identity
Ethnic/Racial/Cultural Identity
4.
In each column, rank your areas of interest (at least three).
TYPE OF SETTING/PROBLEM FOCUS
Child Welfare/ Foster/ Adoption/
Protective Svcs
Community Organizations (macro)
Developmental Disabilities
Family Service/Multi Service
Forensic/Corrections/Court
Foundations (macro)
Government (macro)
Health/Public Health
Hospice
Housing/Shelters
Legislative (macro)
Mental Health: Outpt/Inpt/Day
Tx/Community Based
Nursing Home/Assisted
Living/Community-based
Planning and Program
Development (macro)
Political and Social Action (macro)
Schools: Public/Therapeutic
Substance Abuse: Outpt/Inpt/Day
Tx/Community Based
Other (specify)
5.
POPULATION SERVED
Infants and Preschool
Middle Childhood
Adolescents
Adults
Elderly
Homeless
Families
GBLTQ
Females
Males
Military/Veterans
Newcomers &
Refugees
People of Color
(specify)
Ethnic Groups
(specify)
People with
Disabilities (specify)
Other (specify)
If there is any additional information about you or your background that would be helpful for
us to have in making your assignment, please comment: