Residential
Bachelor of Science in Social Work
Gate One Application
2015-2016
2015-2016
Spring 2016
LU SOWK Gate One Application Packet
GATE ONE ADMISSIONS REQUIREMENTS CHECKLIST
 Complete and submit a Summary of Prerequisites (page 3) showing completion of at least 30
semester hours of the general education requirements and successful completion or current enrollment
in the following courses:

SOWK 101 Introduction to Social Work

SOWK 120 Social Work Field
Exploration

PSYC 101 General Psychology

SOCI 200 Introduction to Sociology

SOWK 260 Chemical Dependency

SOWK 150 Intensive Social Work
Observation

HLTH 216 Interpersonal Health

SOWK 270 Ethics in Professional Helping

BIOL 102 Human Biology
 Earn a cumulative GPA of 2.5 or better. Submit a copy of your Degree Completion Plan Audit
(DCPA) from CRM. Make sure your DCPA is current. (Students must have a C or better in all
social work classes).
 Complete and submit the Gate One Application to the social work office, including an
Autobiographical Statement detailing your interest in social work.
Please also note that certain laws and judicial actions override our commitment to mutual confidentiality. These
include mandated reporting of physical or sexual abuse of children, incapacitated adults and elders, threats of
suicide or homicide, and other statutes required by law. Please consult your ethics codes and state policies for
further information. Additionally, university policy requires faculty to contact the Title IX Office when a
student reports past or present abuse. In cases like this, your privacy will be respected by the Title IX office;
however, you will be contacted by them so they can offer you supportive resources.
 Submit three Letters of Recommendation.

Pastor, youth pastor, or volunteer supervisor

Professional

Colleague or adult friend (over 25 that has known you for at least 2 years)
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LU SOWK Gate One Application Packet
SUMMARY OF P RE/CO-REQUISITES
Name: ________________________________________________________________________
ID#: __________________________________________________________________________
Advisor: _______________________________________________________________________
Cumulative GPA: _____________________________________ (must have a 2.5 or better)
Date: _____________________
Signature: ___________________________________
PREREQUISITE COURSES: Please indicate grade received for these required courses. (IF A
COURSE HAS NOT BEEN TAKEN, PLEASE PUT DOWN WHEN IT WILL BE; INDICATE IF
WAIVED).
1. ________
SOWK 101
6. _________
SOCI 200
2. ________
SOWK 120
7. _________
HLTH 216
3. ________
SOWK 150
8. _________
SOWK 260
4. ________
PSYC 101
9. _________
SOWK 270
5. ________
BIOL 102
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LU SOWK Gate One Application Packet
GATE ONE ADMISSIONS APPLICATION
_________________________________
(Name)
_______________________________
(Present Address, City, Zip)
________________________
(Cell Phone)
___________________________________
(Email)
___________________________________
(Permanent Address, City, Zip)
Do you text and receive texts on your cell phone? ________
EDUCATION
________________________________________________________
(Name of High School)
_________________________________________________
(City, State)
__________________________
(Graduation Date)
____________________________________________________________________________
(Name of other Colleges attended)
_________________________________________________
(City, State)
_________________________________________________
(Expected Date of Graduation from Liberty University)
4
EMPLOYMENT AND VOLUNTEER HISTORY
(Place of Employment—present or most recent)
Dates of Employment
Responsibilities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Place of Employment—previous)
Dates of Employment
Responsibilities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Place of Employment—previous)
Dates of Employment
Responsibilities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Place of Employment—previous)
Dates of Employment
Responsibilities: _______________________________________________________________
______________________________________________________________________________
5
EXTRACURRICULAR ACTIVITIES
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
PERSONAL INFORMATION
My strengths:
I use my strengths in these situations:
Areas where I recognize I need to improve:
I am attempting to grow in these areas by:
My career interests upon graduation are:
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OTHER PERTINENT INFORMATION
Is there any additional information you would like to share that would help us maximize your
experience?
______________________________________________________________________________
______________________________________________________________________________
Transportation Plan for Field Experience
______________________________________________________________________________
______________________________________________________________________________
Driver's license (check one):
Insured car available (check one):
In case of emergency, notify:
Name
Phone Number ___________________________
Address _______________________________________________________________________
City _________________________________________________________________________
State
______________________________________
Zip __________________________
Email _________________________________________________________________________
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AUTOBIOGRAPHICAL STATEMENT
Please type and attach to the application a statement that will allow the Social Work Department
to understand more fully your interest in this field of education (four to five pages). Please
include the following information in your narrative.
1. Your family and significant family relationships.
2. Your life experiences, which have shaped your desire to go into social work.
3. Your experiences in helping people, including those with backgrounds and characteristics
different from your own. How well do you deal with diversity and value differences?
You will need to commit to providing compassionate and effective help to all people.
Are there any people you could not commit to learning how to help? Support your
responses with examples.
4. Your career goals and plans for achievement.
5. Address how Micah 6:8 applies to the practice of social work.
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LETTER OF RECOMMENDATION FOR SOCIAL WORK EDUCATION
Students: Please complete the top portion of this form prior to providing the entire form to
your recommender.
Name of Student ____________________________________________________________
Name of Recommender _______________________________________________________
Role of Recommender______________________________ Length of Relationship _________
Address of Recommender _________________________________________________________
The Family Educational Rights and Privacy Act (FERPA) provides individuals with the right to
view statements of recommendation. However, you may waive your right to review this
recommendation. Please indicate if you are waiving your right to view this recommendation.


I waive my right to view this recommendation
I do not waive my right to view this recommendation
Signature of Student ________________________________________________________
______________________________________________________________________________
Completed by the Recommender
The above named person is applying to the social work program at Liberty University. Please
include your recommendation and comments regarding the applicant in any of the following areas
of which you have knowledge: intellectual capacity, ability to work with diverse people,
professional abilities, ability to perform under pressure, areas of needed growth, and sensitivity to
people. You may write on the back of this form if you need more room.
Your recommendation:
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In what capacity and for how long have you known the student?
Please rate this student in terms of his/her overall potential for the practice of professional social
work:
1. Excellent
2. Above Average
3. Average
4. Below Average
Additional Comments ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name (please print) ______________________________________________________________
Position and Title _______________________________________________________________
Address ______________________________________________________________________
Date _______________ Signature _________________________________________________
Please return this form to the Social Work Department, Liberty University, 1971 University Blvd,
Lynchburg, VA 24515 or scan and email to residentialsocialwork@liberty.edu. If you have
questions, you can reach the faculty support coordinator for the social work program, Zack
Grafman at the same email address.
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GATE ONE INTERVIEW F ORM
Completed by the Student
Name of Student ____________________________________________________________
The Family Educational Rights and Privacy Act (FERPA) provides individuals with the right to
view statements of recommendation. However, you may waive your right to review this
recommendation. Please indicate if you are waiving your right to view this recommendation.


I waive my right to view this recommendation
I do not waive my right to view this recommendation
Signature of Student ________________________________________________________
Please also note that certain laws and judicial actions override our commitment to mutual
confidentiality. These include mandated reporting of physical or sexual abuse of children,
incapacitated adults and elders, threats of suicide or homicide, and other statutes required by law.
Please consult your ethics codes and state policies for further information. Additionally, university
policy requires faculty to contact the Title IX Office when a student reports past or present abuse. In
cases like this, your privacy will be respected by the Title IX office; however, you will be contacted by
them so they can offer you supportive resources.
Date and Time of Interview ___________________________________________________
Interviewer(s) ______________________________________________________________
1. Student’s personal testimony and family history
2. Student’s awareness of personality traits (strengths and areas of needed growth)
3. Student’s goals
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4. Student’s understanding of social work roles
a.
What are the roles?
b.
What roles do you see yourself in?
5. Student’s comparison of and contrast with personal values and social work values
a.
What are the social work values?
b.
Do any of the social work values conflict with your worldview? If yes, describe.
Interviewer(s) Recommendation/Assessment:
Student’s verbal communication skills
Student’s appearance (professional?)
Student’s presentation of self
Any noted areas of concern
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Gate One Admission Recommendation:
 Pass through Gate One
 Gate One Provisional Decision
 Deny Gate One procession
If Gate One procession is provisional, please detail the provisions.
Name: __________________________________________________
(Faculty Interviewer)
Date: ______________
Name: __________________________________________________
(Faculty Interviewer)
Date: ______________
Reviewed: _______________
Name: ___________________________________________________ Date: ______________
(Program Director)
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