University of Nevada, Reno │ School of Social Work, Field Education Program
Agency/Setting Application
Please refer to agency brochure for complete discussion of agency/setting responsibilities and selection process.
Date (MM/DD/YYYY)
Agency/Setting
Address
City, State, Zip
Director/C.E.O. (First and Last Name)
Email
Primary Contact (First and Last Name)
Email
Phone
Fax
Website
Mission
Primary Practice Area (please make one selection)
Administration
Aging/Gerontological Social Work
Alcohol, Drug, or Substance Abuse
Child Welfare
Community Planning
Corrections/Criminal Justice
Developmental Disabilities
Domestic Violence or Crisis Intervention
Family Services
Group Services
Health
Housing Services
International
Mental Health or Community Mental Health
Program Evaluation
Public Assistance/Public Welfare (not child welfare)
Occupational
Rehabilitation
School Social Work
Social Policy
Other:
Department(s)/Project(s) in which Student(s) will be placed
Please describe how the agency’s/setting’s services, activities and teaching philosophy create
appropriate learning opportunities for students.
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University of Nevada, Reno │ School of Social Work, Field Education Program
Availability of social work supervision
Name and Phone Number of Field Instructor(s)*
On-site
Off-site*
BSW
MSW
1.
2.
3.
4.
5.
*If agency/setting is utilizing off-site field supervision, please list the Task Supervisor(s) that will provide dayto-day supervision of the student below
Name
Phone Number
Degree
Length of Time with Agency
1.
2.
3.
Student Duties/Responsibilities
Please indicate the number and type of students your agency/setting can accept and describe the learning
opportunities available.
Generalist Practice (BSW and MSW 1st practicum):
(enter number of students)
Specific
Practicum
Duties/
Responsibilities
*Please refer to
brochure for
description and
examples of
generalist education
competencies.
Advanced Generalist Practice (Final year of MSW/Advanced Standing):
Please continue to next page
(enter number
of students)
University of Nevada, Reno │ School of Social Work, Field Education Program
Does your agency require any of the following?
Yes
No
Student Pays
Agency will cover
this cost
Background Check
Pre-placement orientation/Training
Requirements
Other:
Other:
Other:
Is financial support available (i.e. stipend salary, travel reimbursement, etc)?
No
Yes, describe:
Diversity
The School of Social Work strives to provide a learning environment in which respect for all persons and
understanding of diversity and difference are practiced. Please describe how the agency/setting can contribute to
this effort through representation and support of diversity.
Integrative Project
MSW Concentration students may elect “Option B: Integrative Project” for their graduate studies. The integrative project
requires that students respond to an identified need of the agency/setting in which they are placed for their field practicum.
While the students will work independently on this project, they will need the agency’s/setting’s support in identifying a
need and gaining access to resources as they work toward a response/solution/product. The School of Social Work will
provide training and support to agencies/settings in order to facilitate a successful integrative project experience. Please
read the following description and then indicate whether or not your agency is willing to provide opportunities to complete
this field-based project.
The Integrative Project Option is designed for students who wish to demonstrate their mastery of advanced generalist
practice principles and skills through the completion of a field-based project. Option B students will enroll in the
Integrative Project during the final fall and spring semesters of their concentration year of study.
Field-based issues, problems, or questions—originating from the student’s field practicum site–provide the basis for the
integrative project.
The integrative project must:
A. Demonstrate to faculty, outside evaluators, and others, the student’s ability to synthesize social work knowledge and
apply it to advanced generalist practice;
B. Illustrate this in-depth understanding by demonstrating the student’s ability to effectively address the five areas of
advanced generalist practice—1) theory; 2) practice in micro, mezzo, and macro arenas; 3) policy; 4) research; & 5)
diversity/activism/social justice—to a field-based issue, problem, or question; and,
C. Result in a permanent product that “gives back” and is relevant to the professional practice arena.
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University of Nevada, Reno │ School of Social Work, Field Education Program
Yes, agency/setting is willing to provide Integrative Placement opportunities
No
Date
Signature of Agency Representative
Return this signed form to:
University of Nevada, Reno
School of Social Work/090
Reno, NV 89557-0090
Attention: Field Education Program Coordinator
Please keep a copy of your Agency Application for your records.
Thank you for your interest in the School of
Social Work Field Education Program!
FOR OFFICE USE ONLY
Describe action taken:
Date
Teaching
philosophy
consistent
with School
Mission and
Learning
Environment
Field Education Program Coordinator
Able to
provide
appropriate
learning
opportunities
No, explain:
Able to
provide
appropriate
supervision
Yes
Relevant
Practice
experiences
Site approved?
Action
Taken? If
Yes, describe
below
License
Verified
Field Instructor/Task Supervisor