Revised Oct 28, 2015, BSW Spring Application1
Department of Behavioral
Sciences
Social Work Program Admission Overview
The admissions process for the WSSU Social Work Program has been designed to help both you
and the Social Work faculty decide if Social Work is the right major for you. To become Social
Work majors, students must formally apply to and be accepted into the Social Work Program.
The application process and subsequent student evaluation for acceptance into the Social Work
Program is described below.
To be accepted into the program, students must apply to the BSW Program no later than
Monday, December 7, 2015. In order to be considered for acceptance into the Social Work
Program, a student must have successfully completed a minimum of 36 hours in general
education requirements and SOW 3363-Introduction to Social Work, with a grade of “C” or
higher, and have an overall GPA of 2.0.
A transfer student may declare Social Work as his or her intended major; however, admission to
the Social Work Program is dependent upon the following:
• Completion of the general education courses with a minimum GPA of 2.0
• Completion of SOW 3363-Intro to Social Work with a “C” or higher
• Submission of an application for acceptance after fulfilling these two requirements.
The Social Work Program Committee will review applications for acceptance twice each year
and admit qualified students into the program. A summer deadline will be established and
provided by the Social Work Program Committee at a later date.
Prior to applying to the Social Work Program, students are expected to have read the NASW
Code of Ethics. A copy of the NASW Code of Ethics is available on the NASW website:
http://www.socialworkers.org/pubs/code/default.asp
To apply for admission to the Social Work program, students must meet the follow conditions:
 successfully complete a minimum of 36 credit hours in general education
requirements;
 successfully complete SOW 3363-Introduction to Social Work, with a grade of “C”
or higher, and
 have an overall GPA of 2.0;
Revised Oct 28, 2015, BSW Spring Application2
 submit a current copy of the official transcript
 sign a contract indicating that they read and agreed to the follow the Code of Ethics of
the National Association of Social Workers (NASW);
 secure two letters of reference;
 Complete required 20 (twenty) volunteer hours.
Special note: If you need to acquire a volunteer site to complete the aforementioned
volunteer hours please consider using this link http://www.wssu.edu/campuslife/dean-of-students/career-development-services/project-give/students.aspx to
access WSSU's project give booklet for instructions.
A transfer student may declare Social Work their intended major; however, admission to the
Social Work Program is dependent upon the following:
 Completion of the general education courses with a minimum GPA of 2.0;
 Completion of SOW 3363-Intro to Social Work with a “C” or higher;
 Submission of an application with required supporting documents.
 All documents must be submitted together in a sealed envelope. The application packet
should be to returned to the attention of:
BSW Admissions Committee
Winston Salem State University
Department of Behavioral Sciences and Social Work
601 Martin Luther King, Jr. Blvd
203 Coltrane Hall
Winston Salem, NC 27110
Telephone: 336-750-2061
The student’s application will be reviewed by the BSW Admissions Committee. Admissions
decisions will be based on:






Your overall GPA at WSSU and/ or from all institutions attended;
Your grade in SOW 3363-Intro to Social Work;
The quality of your personal statement;
The thoroughness of your application and resume;
Documented completion of 20 volunteer hours;
Your recommendation forms (the recommendation forms do need to be written by a
Social Work Professor).
Application Deadline
Student’s completed application packet must be received by 5:00 p.m. Monday, December 7,
2015
Revised Oct 28, 2015, BSW Spring Application3
Behavioral Sciences
And Social Work
Winston-Salem State University
Social Work Program
Application for Admission
First Name
: _______________ Middle____________ Last Name________________
Date of Application: __________________ Banner ID: ___________________
Date of Birth: ____/_____/____
Gender:
____ Female _____ Male
Address: (Local/School Address)
__________________________________________________________________
City: _______________
State/Province: _______ Zip Code: ________
County: _____ Home Phone: __________ Business: ________ Cell: ________
Person to be notified in case of emergency
Name: ______________________________ Relationship: ________________
Address:
______________________________________________________________________________
______________________________________________
Phone: (
Other: (
) ______________________ Home: (
) _____________________
) _________________
Please provide us with your personal information by checking the appropriate box. This
information is voluntary; it is requested to fulfill the reporting requirements of the Social
Work Program. Please print legibly.
Winston-Salem State University is committed to affirmative action and equal opportunity and does
not discriminate on the basis of race, religion, national origin, sex, age, handicap, or sexual
preference in its educational programs, admissions, activities, and employment policies.
Revised Oct 28, 2015, BSW Spring Application4
 Black/Non-Hispanic
Caucasian
Hispanic/Latino
Asian/Pacific Islander
Native American/Alaskan
Other
___________________
___________________
If not a U.S. citizen, please list your country of citizenship________
I have completed at least 42 hours of college courses, have a minimum of 2.0 GPA and I am
applying as a (check all that apply):
Sophomore Junior
Transfer
Transfer with an A.A. or an A.S. degree
Returning, former degree seeking student
Second Bachelor’s Degree
Returning, Social Work Major
Major change student, WSSU
Employment Plans
Will you be employed during your enrollment?
Yes
No
If yes, will your employment be full Time or Part-Time?
Have you had any paid Social Work experience?  YesNo (if yes,
Please explain)
Revised Oct 28, 2015, BSW Spring Application5
Post Secondary Education: List all colleges and universities after high school including
Winston-Salem State University (if you previously attended.)
1. Name: ________________________________________________
Date entered: _____/_____/_____ Date ended: _____/_____/_____
Location______________________________________________________
2. Name: ________________________________________________
Date entered: _____/_____/_____ Date ended: _____/_____/_____
Location______________________________________________________
3. Name: ________________________________________________
Date entered: _____/_____/_____ Date ended: _____/_____/_____
Location______________________________________________________
4. Name: ________________________________________________
Date entered: _____/_____/_____ Date ended: _____/_____/_____
Location______________________________________________________
5. Name: ________________________________________________
Date entered: _____/_____/_____ Date ended: _____/_____/_____
Location______________________________________________________
Have you completed at least 36 general educations hours?
 Yes
No
If no, will you have completed at least 36 credit hours by the end of the
spring semester or summer session II?  Yes
No
Have you completed SOW 3363-Social Work as a Profession (or will you
have completed by the end of this semester) with a grade
of “C” or better?
 Yes
No
Number of Semester Hours Completed: _________________
Overall GPA__________________
Special Skills
Revised Oct 28, 2015, BSW Spring Application6
Are you fluent in a foreign language?
 Yes
No
If yes, which language(s)? ____________________________________
Are you fluent in sign language?
 Yes
No
Do you have computer skills and are you proficient in any computer programs (such as
Microsoft Word, Excel, SPSS, SAS, etc?)
 Yes
No
If yes, which computer skills or proficiencies do you possess?
______________________________________________________________________________
_______________________________________________________________________
Background
Note: Information provided will be held in the strictest confidence by the Social Work Program
Admissions Committee and will not be re-disclosed without a written consent from the student.
In preparation for your field experience, which is required for graduation from the Social Work
program, the program will need some background information. Agencies will frequently ask
about a prospective intern’s history regarding substance abuse, child protective services
substantiations, and/or previous legal involvement, including serious or multiple driving
violations. Most agencies require a criminal record background check and a drug screening prior
to accepting a student as an intern. While this does not preclude placement, it is imperative that
the field coordinator has this information prior to beginning the placement process. Do you have
any special circumstances that will need to be addressed prior to beginning your field placement?
 Yes
No
Have you been convicted of a felony, or are you under investigation or indictment
for a felony offense?
 Yes
No
If yes, to either of the above background questions, please indicate the nature of
the special circumstances and/or alleged offense: _________________________
________________________________________________________________
________________________________________________________________
Note: A felony conviction or pending indictment does not automatically disqualify an applicant
from admission to the Social Work Program. Decision will be made on a case-by-case-basis.
However, non-disclosure or falsifying information will result in denial and/or termination from
the Social Work Program.
Transcripts
Revised Oct 28, 2015, BSW Spring Application7
Please include a copy of the following:
•
•
Winston-Salem State University transcript (unofficial student’s copy available on
Banner.)
Official transcripts from all other institutions you have attended.
Recommendations
You must include two (2) recommendation forms with your application. One (1 recommendation)
must be Academic Reference and the remaining One (1) should be Work (Paid employment)/Volunteer
Reference.
Choose persons to provide recommendations who have recent knowledge of your qualifications and
potential for a career in Social Work. Please try to choose persons who will give you a good reference.
Your references may include a professor, employer, supervisor of your volunteer service, etc. References
may not come from relatives, friends, clergy, therapists and high school teachers. Before providing the
recommendation forms to your references, read and fill in the top of each reference form. Request your
references to enclose the completed form in an envelope you provided, seal it, sign across the seal, and
return the sealed reference to you. Do not open reference letters returned to you. Reference envelopes
that have been opened will not be accepted. Completed recommendations should be included with your
completed application packet. The Reference Form begins on the last two pages of this packet.
1. Name of Academic Reference:_________________________________
2. Name of Volunteer Reference:_________________________________
Personal Statement
You are required to include a personal statement narrative with your application. The personal statement
is a critical part of the application process because it gives the Admission Committee the opportunity to
review your writing skills and provides a great deal of information about you, your experience, and goals.
It should be carefully and thoughtfully prepared. Please use a spell/grammar check. Your personal
statement should be type-written, double spaced and at least three (3) pages in length. Please be certain
to respond to each of the below topics as thoroughly as possible. *
1.
2.
3.
4.
5.
Discuss the major reasons for your interest in the profession of Social Work
What interests, motivations, and experiences do you bring the Social Work profession?
What notable qualities do you regard as your strengths for entry into Social Work?
Describe any experiences that you have had in working with people (voluntary or paid.)
Any limitations, barriers, or areas of continued growth that you face which may need to be
addressed prior to entering the Social Work field and/or your placement experience.
6. What are the NASW Code of Ethics and its purpose? Select one of the ethical principles and
discuss your application of this principle in working with clients.
7. *Discuss any special circumstances that should be considered in your application to the
Social Work Program.
Resume
Revised Oct 28, 2015, BSW Spring Application8
Please provide an up-to-date resume with your application packet. Your resume should include your work
history, volunteer experiences, any honors or awards you have received, and any special skills you may
possess. Applicants should seek assistance from Career Services in writing their resume.
Check List
Application
Transcript
 Documented Volunteer Hours (20 hours)
TWO (2) recommendation forms in sealed/signed envelopes
Personal Statement Narrative
Resume
Review of NASW Code of Ethics
Certification
My application for admission to the Social Work Program is complete and
accurate. I understand that an incomplete or inaccurate application may result in
denial of acceptance or termination from the Social Work Program.
I have read the National Association of Social Workers Code of Ethics and agree to
abide by this code of ethics. I acknowledge that I may be terminated from the
Winston-Salem State University Social Work Program if, in the professional
judgment of the Social Work faculty, a violation of this code occurs.
Signature: __________________
Date: _______________________
-----------------------------------------------------------------------------------------------
FOR OFFICIAL USE ONLY
Date Received: _______________
Received by (name):________________
Revised Oct 28, 2015, BSW Spring Application9
Behavioral Sciences
And Social Work
BACHELOR OF SOCIAL WORK PROGRAM
RECCOMENDATIONFORM
Applicant Last Name: ____________________ First Name: ___________________________________
Instructions to Applicant: This form should be given to individuals who can attest to your
ability, potential, and readiness for undergraduate education and professional Social Work
practice. One (1) recommendation must be an Academic Reference (college instructor,) and the
other remaining (1) recommendation should be Work/Volunteer Reference. Family, friends,
clergy, therapists and high school teachers are not appropriate. If one is not academic and
one is not work/volunteer, please include a statement with your application explaining the reason
for the substitution. Recommendations forms are due by: Friday, January8, 2016
In accordance with Family Education Rights and Privacy Act of 1974, you may waive your right
to inspect this recommendation. Please check the appropriate box and sign below. Should you
desire not to waive the right, you will have access to the recommendation if you enroll in WSSU
Social Work Program. Failing to check the appropriate box will automatically waive your access
to view this recommendation.
 I hereby waive my right of access to this reference __________________________________
Signature
Date
 I DO NOT waive my right of access to this reference________________________________
Signature
Date
Instructions to Recommender: We appreciate your willingness to serve as a reference for
the person applying to our Bachelor of Social Work Program. The WSSU Social Work Program
is seeking individuals who possess the personal qualifications essential to professional Social
Work practice and the academic credentials to successfully fulfill the scholastic requirement
while coping with the demands of undergraduate education. After you have completed this form,
enclose it along with any other separate letter in the envelope provided. Seal the envelope, sign
across the seal, and return it to the applicant.
Revised Oct 28, 2015, BSW Spring Application10
Name: ________________________________________________________________________
Title or Position: _______________________________________________________________
Phone: _______________________________Email:___________________________________
Signature: ____________________________ Date: ___________________________________
Recommendation forms not received by Friday, January 8, 2015 deadline will jeopardize
the applicant’s status and the applicant will not be considered for admission. It is strongly
suggested that recommenders provide a letter of support on university or agency letterhead
in addition to completing the rating scale below. The letter is helpful in fully evaluating the
applicant.
• How would you describe the applicant’s strengths and deficits in terms of
knowledge, attitudes and skills?
• How would the applicant’s assets and deficits aid or hinder him or her in
social practice?
• If you are providing a work/volunteer recommendation, please give a brief
description of the applicant’s work/volunteer duties. Please provide
applicants start/end dates and the hours per week worked/volunteered.
• If you are providing an academic recommendation, please give a brief
description of the applicant’s academic performance in the classroom.
Name of student: _______________________________________________________________
1) How long and in what capacity have you known the applicant?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2) How well do you know the applicant?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3) Please provide any additional information you feel may further explain why the
applicant would or would not be a good consideration for the Social Work Program at
WSSU:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Revised Oct 28, 2015, BSW Spring Application11
4) In comparison with other undergraduate students you have known, how would you
rank the applicant on the following criteria using the descriptive listed below.
Excellent
Good
Average
Below
Average
Poor
Unknown
Motivation to be a Social Worker
Intellectual and problem-solving capacity
Interest in working with diverse groups
Interest in improving the quality of
life for others
Ability to empathize with others
Belief in an individual's capacity for
change
Belief in the dignity of all people
Work habits
Emotional stability for working with
others
Ability to work with others
Initiative and Leadership
Written and oral communication skills
Time management
What is your overall recommendation of the candidate?  Recommended
 Not Recommended
Recommend with Reservations Highly Recommended
If you have not recommended the applicant, or recommended with reservations, please give a brief
explanation___________________________________________________________________
______________________________________________________________________________
Signature________________________________________________
Printed Name: __________________________________________
Place your reference form in an envelope, seal it, and write your name across the seal. Return your
reference to the applicant who is responsible for submitting it to the Social Work Admissions
Committee.