Bachelor of Social Work Program
Personal Statement Form
Date_________________________________
Name__________________________________________________ Age_________
Present Address________________________________________________________
Telephone_____________________________Email___________________________
”Permanent” Address____________________________________________________
Please complete this form and return it to BSW Program Director, Normal Hall, Room
401. You may write on this form and return it or create the form by computer and
submit a typed response. This form is used by social work faculty only and is not a part
of your academic record. Your responses will be reviewed to assist you with your
academic and career planning. If you are having any difficulty responding to any of
these questions, please discuss this with a social work faculty member. This form is
due by May 1st, prior to the interview.
If you need more space, please attach additional pages to this form.
1.
Please explain your reasons for wanting to major in Social Work. Discuss
your career plans in so far as you have formulated them. Your response
should include a discussion on the areas of Social Work practice in which you
have an interest.
2.
Describe (if any) your volunteer or paid human service delivery work or
related experience. Include a description of the setting(s), responsibility(ies),
and time period(s) of the work. Inclusion of a resume would be appropriate.
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3.
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4.
A. What is your present Grade Point Average (GPA)? ____________________
B. How many college credits have you completed? ______________________
C. In the following list, place the grade obtained in all the courses you have
completed. This list represents the course requirements of the Bachelor of
Social Work degree that are part of the program foundation. If you have taken
courses you believe are equivalent, write the title and number of the course in the
space provided.
(Course equivalent title)
ANT 100 – Introduction to Anthropology ____________________________
ECO 100 – Contemporary Economics
____________________________
MAT 101 – Basic Statistics
____________________________
POS 101 – American Government
____________________________
PSY 100 – General Psychology
____________________________
PSY 205 – Lifespan Psychology
____________________________
PSY/SOC 311 – Research Methods
____________________________
PSY 446 – Psychobiology
____________________________
SOC 100 – Introduction to Sociology
____________________________
BIO 161 – Human Biology with Lab
____________________________
Please assess your ability to participate in the Social Work program, with
consideration given to the following:
A. academic ability
B. ability to interact with others individually and in group situations
C. writing ability and confidence
D. plans for further education, if any
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5. Discuss any factors that might influence, positively or negatively, your ability to
participate fully in the Social Work program. For example, family obligations
and/or supports, financial issues, work commitments, medical conditions, etc.
Please be frank.
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6. Briefly state your “philosophy of life” or another way of saying this would be your
personal value system. Discuss the ways in which it complements or is different
from the values and ethics of the Social Work profession. You may want to refer
to the Social Work Code of Ethics (either the National Association of Social
Workers or the Canadian Association of Social Work version).
7. Please write a brief autobiography of your life experiences. This question helps
the Social Work faculty understand you as a person and assists us in offering the
most meaningful educational experience possible within the Social Work
program. Include information about your family background, current family
dynamics, work history, living arrangements, health, hobbies, talents and
interests outside of Social Work, and anything else you deem pertinent.
Describe how any of these experiences impacted your current decision to seek a
Social Work degree.
There might be some life experiences that you may not wish to share in written
form. This portion of the Personal Statement Form may be waived under special
circumstances. It is however, important to articulate your personal reasons for
wanting to be a Social Worker. If you choose to omit certain experiences from
your written response, please share them during the interview.
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MEMORANDUM OF AGREEMENT
BSW PROGRAM FIELD PLACEMENT
The parties to this Agreement are the Bachelor of Social Work Program of the
University of Maine at Presque Isle (BSW) and: ______________________________.
The Bachelor of Social Work Program, in placing students at the above named
agency from __________________________ to ______________________________
agrees to the following responsibilities:
The BSW Program will:
1.
Assess and screen students with regard to readiness for field placement.
2.
With the knowledge of the student, inform the agency of any major area of
concern regarding a student’s readiness for field placement.
3.
Provide students with knowledge of their general responsibilities for the
field placement.
4.
Develop objectives for the field learning experience.
5.
Provide materials to assist field instructors with their role and to enhance
the integration of the field and academic learning experience.
6.
Provide students with the knowledge and guidelines for professional
conduct articulated in the NASW Code of Ethics.
In accepting student for field placement, the agency agrees to the following
responsibilities:
1.
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Assign a qualified field instructor for the student. This involves assigning
a field instructor with knowledge and skill in Social Work and sufficient
time and resources to supervise a student.
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2.
Provide for adequate field instruction. The field instructor is involved by:
a. Meeting weekly with the student (an average time would be one
hour per week, although this will vary over the course of the year
and, in addition, will depend on the individual needs of the student
and the nature of the field assignments).
b. Developing educationally sound learning experiences relevant to
the field objectives of the Bachelor of Social Work Program and the
individual student’s objectives and needs (the experiences should
be of increasing complexity with increasing level of student
autonomy as the semester progresses).
c. Providing the Bachelor of Social Work Program with a resume.
4.
Provide for adequate working space and other resources as needed by
the student for the performance of the field assignments.
5.
Treat students in a nondiscriminatory way with regard to race, ethnicity,
religion, gender, age, sexual orientation, or handicapping condition.
6.
Conduct the programs and services of the agency in a manner consistent
with the guidelines for professional conduct articulated in the NASW Code
of Ethics.
____________________________________
Agency Administrator or Representative
__________________________
Date
____________________________________
Agency Field Instructor
__________________________
Date
____________________________________
Field Coordinator, BSW Program
__________________________
Date
____________________________________
Director of Bachelor of Social Work Program
__________________________
Date
Agency Name: _________________________________________________________
Student Name: _________________________________________________________
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