DUE DATE:
March 1, 2016
UNIVERSITY AT ALBANY
SCHOOL OF SOCIAL WELFARE
APPLICATION FOR 2nd YEAR SUMMER BLOCK FIELD
To be eligible for this field option, a student must meet the following
requirements:
A minimum of 37 credits earned toward the MSW degree
Satisfactorily completed Field Instruction I and II
Minimum of 3 out of the last 5 years of paid full-time employment in social work
Instructions:
The application is constructed as a Word document and text can be typed in or checked off in applicable
sections. Completed applications must include a letter of recommendation from your previous field
instructor, an up-to-date resume and a list of your completed masters-level courses. You may submit a
copy of the advisement worksheet to indicate completed and in progress course work. All applications
should be submitted by the due date to the Field Education Office in Richardson 116.
NAME:
PHONE NUMBER: (
STUDENT ID:
)
CURRENT CONCENTRATION:
EMAIL:
☐ CLINICAL
☐ MACRO
CURRENT OR FIRST FIELD PLACEMENT:
CURRENT OR FIRST FIELD INSTRUCTOR NAME:
Please describe prior employment in social welfare settings. Be specific about roles, populations
served, length of time, etc. Attach a current up-to-date resume to this application, showing
month/year and full or part-time employment.
ADVANCED CONCENTRATION SUMMER BLOCK APPLICATION
Please state your short term career goals, e.g., next five years.
Please give a brief explanation of your reasons for applying for the Block Option.
Please describe the type of advanced concentration field experience you are interested in and
why. Address the following: how placement would relate to your career goals, types of activities
or roles you envision, type of agency and client population, any additional, relevant and helpful
information.
Information related to placement Location:
(If your answer is “no” to any of the following questions, please understand that your options may
be limited)
Do you have a current driver’s license?
☐ YES
☐ NO
Do you have a car available to travel to and from field?
☐ YES
☐ NO
Some agencies expect students to have a car available for
travel-related to the placement (not client transport).
Can you meet this expectation?
☐ YES
☐ NO
ADVANCED CONCENTRATION SUMMER BLOCK APPLICATION
Disabilities:
Reasonable accommodations will be provided for students with a documented disability. Any disability
that requires an accommodation in field requires a formal request for accommodation be made to the
University at Albany’s Disabilities Resource Center in Campus Center-137 or (518) 442-5490 as soon as
possible. Thereafter, the Field Office will work with students and field agencies in an effort to provide
such accommodations. Below, please indicate if you will be requesting an accommodation in field as a
result of reported disability that has been filed with the University at Albany’s Disabilities Resource
Center. If not indicated, please write “N/A”.
By signing below, I assert that I am aware of the SSW Standards for Social Work Education. I
understand that any information deemed important to the placement will be shared with the field
instructor. If required for my placement, I agree to complete a criminal background check, child abuse
registry and/or any health screenings (including drug testing, TB and Hepatitis-B test, etc.) necessary for
the acceptance of my field placement. By declining an agency’s request for these required procedures, I
am aware that my refusal will limit my placement options or lead to me not obtaining a field placement. I
understand that a classification as a sexual offender will deem me ineligible for field.
Student’s Signature ________________________________________ Date:______________
ADVANCED CONCENTRATION SUMMER BLOCK APPLICATION