School of Social Work
Bachelor of Social Work Program
APPLICATION TO THE SOCIAL WORK MAJOR*
The Social Work major leads to a professional career. It is based on values about human beings, a broad-based
body of knowledge, and skills in human relationships. We want to help you to develop an integrated selection of courses
and experiences which will lead you to complete the major successfully. The following information will be useful in the
application and advising process within the School of Social Work.
Today’s Date: _____________________________
STUDENTS WHO ARE FORMALLY ADMITTED TO CLEVELAND STATE UNIVERSITY
MAY APPLY TO THE SOCIAL WORK MAJOR
Part I – Personal Information
Name: _____________________________________________ CSU ID: ______________________________
Address: _________________________________________________________________________________
City: _____________________________________ State: __________Zip Code: _______________________
Phone Number: (Home)
(Cell)
.
(Work)
Email: ___________________________________________________________________________________
Please Submit:
(1) Letter of Reference
Checklist from CLASS Advising Center
(Chester Building, Room 279)
Declaration of
Major form
Part II – Educational Information
College within CSU currently enrolled: ________________________________________________________
(College of Liberal Arts and Social Sciences, College of Business, etc.)
Current number of college credits: ____________ Other Dual major/minor: ________________________
List any other Colleges and/or Universities attended:
College/University Name & Location
Date(s) Attended
Major/Degree/Certificate
Term/Year of Date
Graduated/Transferred
________________________________________ / _______________ / ______________________________ / __________________
________________________________________ / _______________ / ______________________________ / __________________
________________________________________ / _______________ / ______________________________ / __________________
*IMPORTANT! Applicants should be aware that having a prior felony conviction or prior sanctions for unprofessional
conduct may impact your future potential of obtaining field placements, social work employment, and/or state licensure.
School of Social Work
Bachelor of Social Work Program
Part III – Employment/Volunteer Information
Work Experience (list any and all work or volunteer positions, paid or unpaid):
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
Organizational Service (social, religious, political, community, etc. that you wish to include):
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
Group Experiences (participant/member, officer, facilitator, group leader):
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
Goals after Graduation (career expectations, graduate school):
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
Part IV – Social Concerns & Issues
Do you have any life experiences and/or significant accomplishments that you wish to be considered with
this application to the social work major? If so, please describe below:
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
Do you have any special needs that the school of social work can assist you with during your course of
study in the social work major?**
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
School of Social Work
Bachelor of Social Work Program
What population of people do you think you would like to work with and why?
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
What, if any, populations and/or social problems/issues do you think you’d prefer not to work with at this
time and please explain why?
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
Are there any additional comments and concerns that you wish to make that would help us plan your
program in the major? If so, please describe below (and continue on the other side of this form if you
need more space).
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
The information I have provided above is both accurate and complete. I further understand that this
information is for the sole purpose of applying to the Social Work major and such information will not be used
for any other purpose.
Signature: _____________________________________Date ______________
Student
It is mandatory to meet with the Coordinator (Dr. Christopher Mallett) of the BSW program (Room 324-Chester
Building – Telephone: 216-523-7514, email: bsw@csuohio.edu) to finalize your Social Work major application.
Signature: _____________________________________Date ______________
BSW Program Coordinator
Cleveland State University is an Equal Opportunity Institution. No person will be denied opportunity for employment or education or
be subjected to discrimination in any project, program, or activity because of race, color, religion, sex, sexual orientation, national
origin, ancestry, age, handicap, or Vietnam veteran’s status.
**”Educational access is the provision of classroom accommodations, auxiliary aids and services to ensure equal educational
opportunities for all students regardless of their disability. Any student who feels he or she may need an accommodation based on the
impact of a disability should contact the Office of Disability Services at 216.687.2015. The Office is located in MC 147.
Accommodations must be requested in advance and will not be granted retroactively.” MLA Policies and Procedures Notebook