East Carolina University School of Social Work
MSW Field Education Application Information
The Field Education Office coordinates the placement process for all students; students are not to secure their own
internships. The process for placement begins in the semester prior to beginning field and includes submitting a field
application, an interview with field staff, and an agency interview. Full time MSW students are typically in field
Wednesday through Friday, schedules vary for part time MSW students. MSW students complete a one semester
foundation internship and a two semester long advanced internship. Advanced Standing MSW students are exempt
from the foundation internship. During your field placement you will attend a field seminar. More information on Field
Education is available on the field website: http://www.ecu.edu/cs-hhp/socw/field-education.cfm .
Applying for Field Education
You must have completed all required social work courses before you can enter field. You will need to register for the
field seminar course and submit a completed field application including all attachments. When you submit your
completed application to the field office you can schedule an interview with the field staff. Be prepared to discuss your
interests and any information that might affect your placement or performance in field during this interview.
East Carolina University seeks to comply fully with the Americans with Disabilities Act of 1990 (ADA). Students requesting
accommodations based on a disability must be registered with the Department for Disability Support Services located in
Slay 138 [(252) 737-1016 (Voice/TTY)]. Please make the field office staff aware of any requested accommodations.
Field placements will be within a 60-mile radius of the student’s campus. It is the student’s responsibility to provide
reliable transportation to the agency. Students should possess a valid driver’s license with appropriate automobile
insurance coverage.
Field agencies may require a criminal background check, drug screening, and/or specific vaccinations prior to accepting a
student as an intern. Field agencies may also check with registries such as the Child Abuse Registry, Elder Abuse Registry,
Healthcare Registry and Sex Offender Registry. The student may be responsible for paying for these. Agencies make the
decision about whether information discovered in the course of the background check will affect the acceptance or
rejection of the student for an internship within the agency.
All students entering field are required to take the ECU HIPAA training course on Blackboard. You will receive an email
notifying you that you have been registered for this course. You will need to complete the online course with a passing
grade.
The Application Process
Students are required to submit a completed electronic form of the MSW Field Education Application to
SWFIELD@ECU.EDU , by the announced deadline. It is the student’s responsibility to apply for their field experience by
the stated deadline. Students missing the stated deadline may be delayed in entering field or may have to postpone
their field placement for a later semester. A complete application for Field includes: the Field application form, a
current picture and a copy of your current resume. The semester before your internship the Field faculty will visit your
classes and provide additional information on how to complete the field application.
When you submit your completed electronic form of the Field Application to the Field Office, you will be contacted by
your assigned field placement coordinator to schedule an individual interview. Be prepared to discuss your learning
needs and placement possibilities. If you have any questions or concerns about the application process for your MSW
field assignment, please contact the Field Education Office at 328-4383.
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Student Internship Agreement
Please read the following agreement carefully before signing. You will be held accountable for these
responsibilities and information. You will not be eligible to enter field until you have signed the agreement
and initialed each item. If you have questions about any item, please discuss it during your interview with the
Field Office. Providing incorrect or deceptive information or violations of this agreement will result in
corrective action, and possible termination of the internship and/or dismissal from the MSW program.
By signing this agreement, I agree to the responsibilities and guidelines listed below. I also agree to take
responsibility to know and adhere to field policies and procedures. I give my written consent to the School
of Social Work at ECU to disclose information from my education records to the internship agency as
required by the School for placement in an internship.
I understand that any violations of this agreement can result in my removal from the internship, and may
affect my ability to complete the MSW program.
Student signature
Date
As an applicant for Field Education, I agree to the following (initial each item on the line):
_____ 1.To act professionally and ethically. This includes, but is not limited to, adhering to the Code of Ethics of
the National Association of Social Workers, maintaining confidentiality, and giving priority to the rights and
needs of clients over my own.
_____ 2. To adhere to the ECU Student Code of Conduct. This includes refraining from use of alcohol or drugs and
other behaviors restricted by the Code. I understand that a positive drug screening will make me ineligible
for field. The Student Code of Conduct is available at: http://www.ecu.edu/osrr/ .
_____ 3. To disclose fully and honestly the information requested by the Field Office.
_____ 4. To follow the policies, procedures, programs and operating standards of the placement agency.
_____ 5. To authorize the School of Social Work faculty to discuss my learning needs, progress and other
information relevant to my internship with other faculty members, Field Instructors, Task Supervisor and
agency contact persons as they deem necessary.
_____ 6. If my field work or professional development is not deemed satisfactory by social work faculty, agency, or
me, either party has the right and the responsibility to request reassessment of my suitability to continue in
the field.
_____ 7. Prior to beginning my internship I will read the Field Manual and be responsible for understanding the
information it contains. I will be familiar with all field guidelines, policies and procedures, including:
 Process for securing a field placement
 Attendance policies
 Evaluation and grading
 Procedures for problems solving, including grievances, requesting changes and
terminations in field
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ECU School of Social Work
MSW Field Education Application
Please complete provide all information required on this application and sign the verification statement. If you have any
questions about an item on the application, please contact the Office of Field Education at 252-328-4383.
My signature below signifies that all information on this application is true and valid. I understand that providing
incomplete or false information can make me ineligible for a field internship.
Student signature
Date
1. Name:
__
Banner ID number (required) ____________________________
Phone: (
)
_______
Date:
Overall GPA (most recent)
Alternate Phone: (
)
ECU Email address:
2. Please check applicable:
MSW I
ON CAMPUS
MSWII
ADVANCED STANDING
OFF CAMPUS COHORT (indicate city)
3. Your Address While Attending ECU:
City
State
Zip
State
Zip
4. Permanent Home Address (if different from above):
City
5. Where will you reside during placement?
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University
Home
3
6. Are you bilingual? Yes
No
If yes, which language(s)
Proficiency Level:
beginner
intermediate
advanced
7. Students are responsible for transportation to their placement, regardless of location. Please note that your
Internship may be up to 60 miles away. Because public transportation is limited, it is strongly recommended that
students have a reliable vehicle. Lack of reliable transportation will significantly limit your placement
opportunities.
Do you have a valid driver’s license?
Yes
Will you have a car available for transportation? Yes___
No
No_____
If no, how do you plan to get to your internship? __________________________________________________
_________________________________________________________________________________________
8. List 3 counties, in order of preference, for your field placement site. Please note that every effort is made to
accommodate student preferences, but location cannot be guaranteed.
1.
2.
3.
9. Students requesting accommodations based on a disability must be registered with the Department for Disability
Support Services located in Slay 138, (252)-737-1016 (Voice/TTY). Students who are requesting accommodations
must submit a copy of their accommodation letter to the Field Office.
Are you requesting any accommodation under the Americans with Disabilities Act of 1990 (ADA)?
Yes
No
10. Dual Roles/ Conflict of Interest
Previous experiences, dual roles or potential conflicts of interest can affect the suitability of certain internship
placements or a student’s performance in field. While these do not necessarily rule out a placement, the Field
Office must have this information prior to beginning the placement process to help ensure appropriate placements.
The Field Office will also help you determine how to present such issues during agency interviews.
If you are unsure about an item, please include it and discuss it during your Field Office interview. The following
questions are to assist this discussion; however there may be other issues that should be considered. Students are
responsible for making the Field Office aware of any experiences that could impact your internship placement.
a. Are you or a close family member receiving (or have you received) services from an agency that could become a
potential internship for you? Yes
No
b. Do you have any family members or close friends employed by any agencies that could become a potential
internship for you? Yes
No
c. Are there any issues that might affect your functioning in your internship? For example, a recent death in the
family, a recent significant life event, issues that may have required counseling, etc. Yes
No
d. Are there any other issues that might affect your performance or placement in field?
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Yes
No
4
11. Legal involvement can be grounds for an agency to decline a student. This includes, but is not limited to : current,
past or dismissed charges; charges of any type including but not limited to: drug or alcohol related charges, bad
checks, traffic violations, speeding, shoplifting, assault, verbal or cyber threats, etc.
Have you ever had any legal involvement, including charges that were dismissed, expunged, prayer for judgment,
etc.?
Yes ____
No ____
Have you ever had any speeding tickets or traffic violations? Yes ____
Have you ever been convicted of a felony? Yes
No ____
No
Please be prepared to discuss this with your Field Placement Coordinator.
12. Do you anticipate being employed part-time during the field placement? Yes ____
No ____
If yes, how many hours per week do you anticipate working? ___________
If yes, write a brief description of how you plan to balance the requirements of field placement and course work
with the requirements of your paid work.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
***The questions below will provide the field office with information on your individual interests and career goals. Every
effort is made to match the student to a field placement that meets their interests. However, please be aware that there
is no guarantee that students will be able to be placed in specific agency or service area. This is due to educational
standards, the voluntary nature of Field Instructors and the limits of community resources. It is important for students to
be open to a variety placement options and service areas***
12. What populations are you most interested in working with during your field placement?
□Children, Adolescents and Families
□Adults
□Seniors
□Any
13. What practice areas are you most interested in working in during your field placement?
□ At-Risk Youth
□ Aging Services
□ Child and Family Services
□ Community Outreach/Program Development
□ Developmental/Intellectual disabilities
□ Domestic Violence
□ Administrative and Macro-Placements
□ Medical/Health
□ Mental Health/ Substance Abuse
□ Poverty/ Self Sufficiency
□ School
□Other ________________________________________________________________________
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14. Are you applying for any of the optional certificates? Yes____
No ____
If you circled yes, please indicate below the certificate you would like to pursue:
□
□
Child Welfare Collaborative
School Social Work
□ Gerontology
□ Substance Abuse
15. What practice skills would you like to work on during your internship? Check all that apply
□Grant Writing
□Case Management
□Advocacy / Community Outreach
□Conflict Resolution
□Crisis Intervention
□Documentation
□Education/Prevention
□Home Visits
□Program Development
□ Intake/Interviewing
□ Assessment
□ Intervention skills
□Other_____________________________________________________________
16. Do you want to be considered for internship placement at your place of work? Yes ____ No ____
To be considered for an Employment Based Placement, you must already be employed at a human service organization.
See the ECU School of Social Work field manual for further details.
If you circled yes, please list the name of the agency where you are employed:
________________________________________________________________________
Please take a moment to review the checklist below to see if you have a completed packet:



An application complete with your signatures
A copy of your current resume
A current photo of yourself
For Field Office use only:
Complete application received from student by:
Field staff signature
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