SUMMER FULL TIME ADVANCED STANDING FIELD PRACTICUM PLANNING GUIDE I. STUDENT INFORMATION Date: (Format: mm/dd/yyyy) Name: Local Information: Address: City: State: Daytime Phone: Zip Code: Evening Phone: Email Address: Summer Information (if different): Address: City: State: Daytime Phone: Zip Code: Evening Phone: Email Address: 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 the necessity of 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 Management and Community Practice Self-Directed 1 SUMMER FULL TIME ADVANCED STANDING 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 A. Briefly describe your BSW field placement (agency name, dates in placement, population served, social work activities, significant learning). B. How did your BSW experience influence your social work interests? C. What do you imagine yourself doing, as a professional social worker, one year after graduation? Five years after graduation? D. What client populations interest you the most? (For example older adults, children, adolescents, individuals with mental illness, persons with disabilities, etc.) E. What social problems are most interesting to you? (For example poverty, child abuse, domestic violence, homelessness, immigration, etc.) F. What supervisory style is the best fit with your approach to learning? 2 SUMMER FULL TIME ADVANCED STANDING 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 match individual student needs with placement learning opportunities. If there are other factors that we should consider as we plan your concentration placement assignment (e.g. religion, culture, sexual orientation, gender expression, health concerns, learning needs, other special needs), please explain below. If there is additional information which you prefer to remain confidential, please contact the Field Education Office to discuss your situation. 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 3 SUMMER FULL TIME ADVANCED STANDING FIELD PRACTICUM PLANNING GUIDE 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. STUDENT PERMISSION 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 Thank you for completing the Advanced Standing Planning Guide 4