ARKANSAS STATE UNIVERSITY DEPARTMENT OF SOCIAL WORK GRADUATE ADMISSIONS P.O. Box 60, State University (Jonesboro), AR 72467 www.astate.edu Phone: (870) 972-3029 Fax: (870) 972-3857 APPLICATION FOR ADMISSION TO THE MASTER OF SOCIAL WORK PROGRAM Before indicating preferences, be sure you meet the requirements for your preferred degree program. (If you mark more than one box, indicate order of preference, i.e. 1, 2, 3) Application for: Standard Master of Social Work Program (Full-time -- 2 Year Program) Standard Master of Social Work Program (Part-time -- 4 Year Program) Advanced Standing Master of Social Work Program (Full-time -- 1 Year Program) Advanced Standing Master of Social Work Program (Part-time -- 2 Year Program) Legal Name: I.D. Number: Last Sex: F First Middle M Email Address: Phone Ethnicity/Race (optional): DOB (Optional) Permanent Address: Mailing Address (If different): Prerequisites completed with a grade of “C” or higher prior to applying. Introduction to American Government Human Biology Introduction to Sociology Social Statistical Methods & Lab or Quantitative Methods & Lab Introduction to Psychology Introduction to Social Work Date your undergraduate degree was awarded Have you taken a Web or Web-Assisted course? Yes Major No Please check this box if you are interested in receiving information about the Addictions Certificate offered through the MSW program at ASU. Arkansas State University educates leaders, enhances intellectual growth and enriches lives. Page 1 Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu 06/07/13 ARKANSAS STATE UNIVERSITY DEPARTMENT OF SOCIAL WORK GRADUATE ADMISSIONS P.O. Box 60, State University (Jonesboro), AR 72467 www.astate.edu Phone: (870) 972-3029 Fax: (870) 972-3857 Background checks and Compliance with ASU-Alcohol & Drug Policy: I. Notice to all applicants re: Section 17-103-307 Criminal background checks (Selected parts). (f) On and after October 1, 1997, each first-time applicant for a license issued by the Arkansas Social Work Licensing Board shall be required to apply to the identification Bureau of the Department of Arkansas State Police for a state and national criminal background check, to be conducted by the Federal Bureau of Investigation. (g) No person shall be eligible to receive or hold a license issued by the board if that person has pleaded guilty or nolo contendere to, or been found guilty of any of the following offenses by any court in the State of Arkansas, or of any similar offense by a court in another state, or of any similar offense by a federal court. (The Social Work Licensing Act and the Regulations for the Administration of the Social Work Licensing Act, 2001, 17-103-307 http://www.state.ar.us/swlb/licensing_info.html). Please review the list of offenses using the web address above to determine if you will qualify for a social work license in the State of Arkansas. Even though you may be admitted to the social work program and successfully complete a social work degree from Arkansas State University, you may not qualify for licensure in this state and/or in any other state. II. ASU Alcohol and Drug Policy. (h) Each student admitted in the MSW program must sign the compliance form for ASU Alcohol and Drug Policy. Refer to Substance Abuse Policy and Procedures, College of Nursing and Health Professions included in student handbook. Signature:____________________________________________________ Date: _______________________________ Please Note: All communication regarding the application process should be via email. For questions regarding admission to the Graduate School: gradsch@astate.edu For questions regarding admission to the MSW program: awinn@astate.edu Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu 06/07/13 The Department of Social Work focuses on micro practice with individuals, mezzo practice with families and groups, and macro practice with organizations and communities (DSW=m3) . ARKANSAS STATE UNIVERSITY DEPARTMENT OF SOCIAL WORK GRADUATE ADMISSIONS P.O. Box 60, State University (Jonesboro), AR 72467 www.astate.edu Phone: (870) 972-3029 Fax: (870) 972-3857 PERSONAL AND PROFESSIONAL SOCIAL WORK GOALS Please write a short paper on your personal and professional social work goals. Utilize The Publication Manual of APA to construct your cover page, content, and reference page including professional citations. In evaluating your writing, the admissions committee will consider the organization of your response, evidence of critical thinking and analysis, that your choice of social work is based upon your own unique skills and life challenges, any current social issues facing our world, and your understanding of social work values and ethics. This paper is limited to five pages maximum (not including cover and reference page). 1. Please discuss your understanding of the profession of social work, your reasons for choosing the profession of social work, influences on your choice, and your future career goals (support your reasoning with citations from the literature). 2. Describe employment and or volunteer experiences in which you exhibited leadership and/or responsibility. How have these experiences readied you for graduate social work education? 3. Describe a situation in which you encountered an ethical issue and utilized social work values and ethics to resolve the issue. 4. Explain your understanding of what is expected of you in pursing an MSW at Arkansas State University. Please identify any special circumstances, if applicable, that have affected your academic history that you think the Admissions Committee needs to consider in making its decision. Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu 06/07/13 DEPARTMENT OF SOCIAL WORK GRADUATE ADMISSIONS P.O. Box 60, State University (Jonesboro), AR 72467 www.astate.edu Phone: (870) 972-3029 Fax: (870) 972-3857 APPLICANT REFERENCE Applicant’s Name: TO THE APPLICANT: Please print or type your reference’s name: Please submit three letters of reference from people who are in a position to provide statements concerning your academic qualifications or your recent or current employment (supervisors, employers, faculty or co-workers). I understand that this reference is to be sent directly to the Graduate Admissions Office by the person writing the reference, and that I agree to: Waive access to this reference TO THE REFERENCE: The above named person is applying for admission to the Department of Social Work at Arkansas State University. The candidate has given your name as a person having knowledge of his or her potential for undertaking graduate study in social work. Please be candid in your assessment of the candidate. If unable to observe the applicant in a specific skill set, please note it below. You may attach a separate letter to this form, if you like. Please send this reference form to the Graduate School by mail, fax or email (P.O. Box 60 – State University, AR 72467; (870)972-3857; gradsch@astate.edu). Since the School’s decision cannot be made until references have been received, we would appreciate a reply at your earliest convenience. Thank you for your cooperation and interest. 1. How long have you known the applicant? 2. 3. In what capacity have you known the applicant? Supervisor Co-Worker Faculty Please evaluate the applicant as fairly as you can in each of the following categories: Not Observed/ Not Applicable Below Average (Bottom 50%) Average (Top 50%) Good (Top 25%) Other Superior (Top 10%) Exceptional (Top 5%) Academic performance Intellectual ability Judgment Potential for contribution to the profession Emotional Maturity Verbal skills Written skills Ability to think critically Warmth Ethics Empathy Genuineness Capacity for leadership Ability to work with diverse persons 4. 5. Please feel free to attach a separate letter providing additional information including any areas of concern. I would: Recommend with enthusiasm Recommend Recommend with reservation. If so, please explain. Do not recommend Name: Organization: Title: Phone: Address: Signature:______________________________________________________ Date: _________________________________ Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu 06/07/13