1600 Holloway Avenue
San Francisco, California 94132-4161
Tel: 415/338-1003
School of Social Work
APPLICATION TO MSW PROGRAM
Please read the admission materials carefully before completing this form.
Name:
Social Security:
Date:
Address:
City:
County:
State:
Telephone No. (Home):
Zip:
Other:
E-mail:
I.
ACADEMIC BACKGROUND
A.
List in reverse chronological order (starting with most recent first) all colleges and
universities attended, including dates, major, and degree received. Please send an
official transcript from all colleges or universities listed below to 1)the University's
Graduate Division, and one official transcript to 2) the School of Social Work.
INSTITUTION
MO/YRS OF
ATTENDANCE
MAJOR
DEGREE
The California State University: Bakersfield, Channel Islands, Chico, Dominguez Hills, Fresno, Fullerton, Hayward, Humboldt, Long Beach, Los Angeles
Maritime Academy, Monterey Bay, Northridge, Pomona , Sacramento, San Bernardino, San Diego, San Francisco, San Jose, San Luis Obispo, San Marcos, Sonoma,Stanislaus
Do you have a BSW from an accredited social work program? Yes____ No____
BSW from SFSU
Yes____ No____
B.
Educational Objectives:
Please describe the educational and career objectives that motivated you to apply to the
MSW program. Relate these objectives to your personal experiences and life goals.
(Limited to 2 pages double-spaced typed, Style: 12point, Font: Times New Roman)
C.
Professional Motivation:
Discuss any environmental or personal obstacles that you have had to overcome in life.
How have your efforts to overcome these obstacles influenced your decision to enter the
field of social work? (Limited to 2 pages double-spaced typed, Style: 12point, Font: Times
New Roman)
II.
POTENTIAL FOR PROFESSIONAL PRACTICE
A.
Employment / Volunteer Experience in the Human Services Field
Full-Time Employment
Employment History: Beginning with your most recent employment, list below all
paid experience in the human services field which you have had in the past ten (10)
years. Please provide verification of employment for your experience, using the
forms enclosed. (Use additional pages if necessary)
Dates Worked
Organization
Position or Title
Total years and months of full time employment__________
Part-Time Employment
Dates
Worked
Weeks
Worked
Hours
Per Week
Total Hours
Organization
Total number of hours of part-time employment in past 5 years______
Position
or Title
B.
VOLUNTEER WORK EXPERIENCE: Beginning with your most recent first, list all
volunteer experience you have had in the human services within the past three years. Please
provide verification of these experiences using the forms enclosed.
Date
HRS/WK
Organization
Position/ Title
Total number of volunteer hours worked within past 6 months________
Total number of volunteer hours worked within past 3 years ________
C.
Discuss any experiences you have in providing services to or working with a specific
disadvantaged group or community (Limited to 1page double-space typed, style: 12 points,
Font: Times New Roman). Please substantiate such experiences with reference letters.
D.
Do you have evidence of demonstrated leadership capacity geared toward improving the
condition of life for disadvantaged groups? If so, describe in detail. (Example: special
projects, presentations, written work, board work, leadership activities). (Limited to 1 page
double-spaced typed, style: 12point, Font: Times New Roman.)
E.
Additional Support Statement: Please specify which area of the application you wish to
further elaborate. (Limited to 1 page double-spaced typed, Style, 12point, Font: Times New
Roman)
III.
CONCENTRATION PREFERENCE
The School of Social Work offers three areas of concentration.
Please check the concentration that seems most congruent with your academic interests and
professional goals. Candidates will be admitted specifically into one of the three
concentrations listed below. Generally, once you have been admitted, you will not be allowed
to change your concentration. Please refer to the School of Social Work Bulletin for details
on the concentration.
___________
ADMINISTRATION AND PLANNING
___________
SOCIAL DEVELOPMENT
___________
SOCIAL WORK PRACTICE WITH
INDIVIDUALS, FAMILIES, AND GROUPS
Your application is for confidential use in the Admissions process of the School and the University.
This application will be destroyed after one year. Information compiled from applications is also
used in reports and in research designed to improve admissions policies and procedures.
I verify that all statements and information contained within this application are correct to the best of
my knowledge.
__________________________________
Applicant's Signature




Check List
Application
Letters of Reference (at least 3)
Verification of Employment
Verification of Volunteer Work
______________________________
Date
Date Completed
1600 Holloway Avenue
San Francisco, California 94132-4161
Tel: 415/338-1003
School of Social Work
_____________________________
APPLICANT'S NAME
TO THE REFERENCE:
The above individual is an applicant to the Master of Social Work Program at San Francisco State University and has
selected you as a reference. Please assist us in our evaluation of this candidate by providing a personal evaluation of
his/her experience and qualifications for graduate professional study. Please note that, by law, this information is
available to the applicant unless s/he waives this right in writing.
_____
I waive my right to review this material
_____
I do not waive my right to review this material
Your observations and opinions about the applicant's potential to become a professional social worker are very important
criteria in the School's admissions process. We appreciate, therefore, your full and frank assessment of the applicant's
strengths and limitations. Our review of this candidate cannot begin until we receive your reference. The reference letter
must be in a sealed envelope, signed across the back flap by the recommender.
Applications MUST be in the School of Social Work office by 5:00 pm on February 1, 2005.
If you need more space, please attach an additional sheet.
Thank you for your assistance.
The School is not responsible for furnishing copies of this reference.
__________________________
Signature of Applicant
***********************************************************************************************
IT MUST BE TYPED OR PRINT
(PLEASE ATTACH ADDITIONAL PAGES AS NECESSARY)
1.
How long and in what capacity (e.g. employer, teacher, friend, etc.) have you known the applicant?
The California State University: Bakersfield, Channel Islands, Chico, Dominguez Hills, Fresno, Fullerton, Hayward, Humboldt, Long Beach, Los Angeles
Maritime Academy, Monterey Bay, Northridge, Pomona , Sacramento, San Bernardino, San Diego, San Francisco, San Jose, San Luis Obispo, San Marcos, Sonoma,Stanislaus
SAN FRANCISCO STATE UNIVERSITY
MSW PROGRAM - REFERENCE FORM
PAGE 2
2.
If you have known this person in a work capacity (paid or volunteer experience,) how would you evaluate the quality
of his/her performance? Specify the applicant's title and job responsibilities.
3. What is your assessment of the applicant's personal qualifications? (e.g. motivation, intellectual capacity, maturity,
clarity of educational goals and objectives, flexibility, self-reliance, etc.)
SAN FRANCISCO STATE UNIVERSITY
MSW PROGRAM - REFERENCE FORM
PAGE 3
4.
Our program emphasizes social work with oppressed/disadvantaged individuals and communities. Comment on what
you know about the applicant's experience working with such populations and his/her knowledge of and commitment
to such groups.
5.
What leadership roles has the applicant exercised in work, community, political or school activities?
SAN FRANCISCO STATE UNIVERSITY
MSW PROGRAM - REFERENCE FORM
PAGE 4
6.
Please indicate how you would rank this applicant in comparison to other students/colleagues you have known?
_____Top 1-2% _____Top 10% _____ Top 25% _____Top 50% _____Other
7.
Please add any other information concerning the applicant, which you feel the Committee should consider.
***********************************************************************************************
Signature:_______________________________________
Date: __________________________________________
Name:
Title: __________________________________________
_______________________________________
Address: ________________________________________
Telephone Number: _______________________________
PLEASE RETURN THIS FORM BY: February 1, 2005
Post marked application will NOT be accepted.
TO: SAN FRANCISCO STATE UNIVERSITY
SCHOOL OF SOCIAL WORK
1600 HOLLOWAY AVENUE
SAN FRANCISCO, CA 94132
Agency: ________________________________________
1600 Holloway Avenue
San Francisco, California 94132-4161
Tel: 415/338-1003
School of Social Work
VERIFICATION OF EMPLOYMENT
This is to certify that _______________________________________ was employed
Name of Applicant
by ______________________________________________________ in the position of
Name of Agency
__________________________________________________________.
Job Title
Full Time
Part Time
From: ______________
Date
To: ____________________
Date
_________________________________
Signature
Date
_________________________________________
Title
__________________________________________
___________________________________________________
Name
Prof. License No. (if any)
__________________________________________
_________________________________________________
Agency
Day Time Telephone No.
This position entailed the following duties__________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
The position required did [ ] did not [ ] require work with oppressed or disadvantaged groups.
Agency Auspices: Non-Profit [ ]
Tax Supported [ ]
(Public)
Private [ ]
(For Profit)
The California State University: Bakersfield, Channel Islands, Chico, Dominguez Hills, Fresno, Fullerton, Hayward, Humboldt, Long Beach, Los Angeles
Maritime Academy, Monterey Bay, Northridge, Pomona , Sacramento, San Bernardino, San Diego, San Francisco, San Jose, San Luis Obispo, San Marcos, Sonoma,Stanislaus
1600 Holloway Avenue
San Francisco, California 94132-4161
Tel: 415/338-1003
School of Social Work
VERIFICATION OF VOLUNTEER FORM
This is to certify that _______________________________________ was employed
Name of Applicant
by ______________________________________________________ in the position of
Name of Agency
_______________________________________________________.
Volunteer Title
Total Number of Hours:______________________
From: ______________
Date
To: _________________
Date
_________________________________
Signature
Date
_________________________________________
Title
__________________________________________
___________________________________________________
Name
Prof. License No. (if any)
__________________________________________
_________________________________________________
Agency
Day Time Telephone No.
This volunteer position entailed the following duties__________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
The position required did [ ] did not [ ] require work with oppressed or disadvantaged groups.
Agency Auspices: Non-Profit [ ]
Tax Supported [ ]
(Public)
Private [ ]
(For Profit)
The California State University: Bakersfield, Channel Islands, Chico, Dominguez Hills, Fresno, Fullerton, Hayward, Humboldt, Long Beach, Los Angeles
Maritime Academy, Monterey Bay, Northridge, Pomona , Sacramento, San Bernardino, San Diego, San Francisco, San Jose, San Luis Obispo, San Marcos, Sonoma,Stanislaus