University of Southern Maine School of Social Work
FIELD PLACEMENT AT PLACE OF EMPLOYMENT CONTRACT
Date____________
BSW____________
Academic year______________
Foundation year____________ Concentration year_________
Student________________________________________________________________
Agency/Organization_____________________________________________________
Field Instructor__________________________________________________________
Employment Supervisor (if applicable)_______________________________________
1. In order for place of employment to be approved as field placement, the following
must have taken place.
Student will have consulted with Field Coordinator and/or Field Associate,
providing preliminary Plan of Study (in written form) outlining how field
placement will differ from paid employment. A current job description should
be attached, as well as a detailed description of the different tasks and duties
that will be considered placement work and a clear statement regarding the
number of hours to be spent in field placement activities.
Field Coordinator and/or Field Associate will have assessed the employment
site for field placement suitability, which includes the appointment of a
qualified Field Instructor. The Field Instructor must be someone other than the
student’s employment supervisor and have a MSW with two years post MSW
experience (for MSW students) or a BSW/MSW (for BSW students).
Agency/Organization will have agreed to adjust the student’s workload in order
for student to carry out responsibilities of field placement and will have
assigned different responsibilities to the student than previously undertaken.
In addition, Agency/Organization will agree to release student from
employment obligations in order to participate in field instruction supervision
for an hour and a half per week, attend classes and complete required course
work.
Agency/Organization Field Instructor will make every attempt to attend Field
Instructor training and submit evaluations at the end of each semester.
Preliminary Plan of Study may have been revised following consultation with Field Faculty
Liaison, and Field Coordinator and/or Field Associate. Please attach a final, revised Plan of
Study to Place of Employment Contract.
Student, Field Instructor and Work Supervisor sign Place of Employment Contract.
Forward signed Contract with attached Plan of Study to Field Coordinator and/or Field
Associate.
We have read and agreed to the attached Plan of Study for ____________________
to do a field placement at our agency/organization. We agree to all conditions and will
support the student in completing field placement tasks and activities.
________________________________________________
_________________
Agency/Organization Work Supervisor
Date
________________________________________________
_________________
Field Instructor
Date
________________________________________________
_________________
Student
Date
The Field Coordinator and/or Field Associate will make a final decision on the proposal
and notify the student as soon as possible. Field hours cannot be counted until final
approval and notification takes place and until student is enrolled in Field Work Seminar.
Reviewed by: _____________________________________
Field Coordinator and/or Associate
Approved_____
_________________
Date
Not approved_____
Please provide us with the contact information for your field instructor below:
Name: _________________________________________________
Address: _______________________________________________
Email address: __________________________________________
Phone number: __________________________________________