B-HIPP Salisbury Intern Program Application and Checklist Name:

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B-HIPP Salisbury Intern Program Application and Checklist
Please type application before printing and submitting to the Field Office. Please direct
any questions to Mrs. Habeger [email protected] 410-677-3923 or 410-2519162.
Name:
2013-14 status:
Phone number:
Email:
Address:
2nd Year (Concentration)
OR
Advanced Standing
Foundation Placement Agency:
Supervisor’s Name:
Description of duties at agency:
Paragraph detailing career goals after obtaining MSW degree:
Desired area of placement: (placements will be made based on preference and best fit
with available offices)
 Somerset County
 Wicomico County
 Dorchester County
 Talbot County
Checklist:
 Completed application
 2 letters of reference from field liaison, field supervisor, and/or faculty
 1-2 page essay detailing pediatric primary care/behavioral health integration and
your view on the role of a social worker in this setting (it is expected you will do
some research on this topic prior to writing your essay).
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