University of Arkansas Bachelor of Social Work Program Application
Page 1 of 4
Please type all responses to the below questions, save as a word document, print, and submit to the BSW
Program with your other application materials. See application instructions at
http://ualr.edu/bsw/index.php/home/admissions-info/ .
Applicant Information
Date of application (mm/dd/yy):
Last name:
T#:
First name:
MI:
Street Address:
City:
State:
Phone: (
ZIP Code:
E-mail1:
)
When would you prefer to take most of your social work classes:
Day
Evening
Would you like to be considered for early decision status (please see requirements): :
Yes
No :
Uncertain
Emergency Contact Info2
Name:
Relationship:
Phone: (
)
Name:
Relationship:
Phone: (
)
Please list all schools you have attended since high school, beginning with the most recent:
Credit hours taken
Dates
Institution & location
(excluding
Overall GPA
(mm/yy)
developmental)
–
–
–
–
–
–
What is your overall GPA from all institutions you have attended?
Do you have an AA, AS or AAT degree?
Do you have a Bachelor’s degree?
Yes
No
If YES, from:
Date of Associate3 degree:
If YES, from:
Date of Bachelor4 degree:
If you already have a Bachelor’s degree, what was your GPA in your last 60 hours of coursework?
Yes
No
Please indicate your grade in each of your three prerequisite courses:
Introduction to Social Work
Semester & year:
Grade:
Location:
(SOWK 1300)
Introduction to Sociology
Semester & year:
Grade:
Location:
(SOCI 2300)
Psychology & Human Experience
Semester & year:
Grade:
Location:
(PSYC 2300)
Overall GPA in three prerequisites:
Please continue to Page 2.
Footnotes are detailed in the application instructions document.
Rev June 2014: SCT
University of Arkansas Bachelor of Social Work Program Application
Page 2 of 4
Please type all responses to the below questions, save as a word document, print, and submit to the BSW
Program with your other application materials. See application instructions at
http://ualr.edu/bsw/index.php/home/admissions-info/ .
Please list the names of three people who have agreed to provide you with an academic or professional
reference (i.e., instructors, employer, volunteer supervisor). One reference must be from your Introduction to
Social Work instructor. References must include the appropriate form (included with this packet).
Full Name:
Email:
Relationship:
Phone:
(
)
Address:
Full Name:
Relationship:
Address:
Email:
Phone:
(
)
Full Name:
Relationship:
Address:
Email:
Phone:
(
)
Beginning with your most recent job, please list all jobs you have held since graduating from high school.
Attach additional pages if necessary.
Company:
Address:
Job Title:
Responsibilities:
Dates (mm/dd/yy):
Company:
Address:
Job Title:
Responsibilities:
Dates (mm/dd/yy):
-
Company:
Address:
Job Title:
Responsibilities:
Dates (mm/dd/yy):
-
Company:
Address:
Job Title:
Responsibilities:
Dates (mm/dd/yy):
Please continue to Page 3.
Footnotes are detailed in the application instructions document.
Rev June 2014: SCT
University of Arkansas Bachelor of Social Work Program Application
Page 3 of 4
Please type all responses to the below questions, save as a word document, print, and submit to the BSW
Program with your other application materials. See application instructions at
http://ualr.edu/bsw/index.php/home/admissions-info/ .
Please list all organizations with which you have volunteered or performed some sort of community service,
along with a brief description of your volunteer responsibilities. Attach additional pages if necessary.
Organization:
Dates (mm/dd/yy):
Total hours volunteered:
Responsibilities:
Organization:
Dates (mm/dd/yy):
Responsibilities:
-
Total hours volunteered:
Organization:
Dates (mm/dd/yy):
Responsibilities:
-
Total hours volunteered:
Organization:
Dates (mm/dd/yy):
Responsibilities:
-
Total hours volunteered:
Organization:
Dates (mm/dd/yy):
Responsibilities:
-
Total hours volunteered:
Military Service
Have you ever served in the military?
Yes
No
If YES, please include a copy of your DD214 with this application.
Felony Conviction
Have you ever been convicted of a
If yes, please explain:
felony4?
Yes
No
Disclaimers and Signatures
I certify that the above answers are true and complete to the best of my knowledge. I am aware that falsifying
information may result in my application to the BSW program being denied.
Yes
No
I understand that in my senior year, I will have to complete an internship of at least 240 hours per semester and that
most internships will require me to be at the agency during normal working hours. I also understand that while I am
enrolled in my internship, I am required to take a field seminar course on Tuesdays from 3 – 5 pm each semester.
Yes
No
I have read the National Association of Social Worker Code of Ethics at http://www.naswdc.org/pubs/code/code.asp or
elsewhere and I am aware that violations of the Code of Ethics may result in dismissal from the University of Arkansas
at Little Rock Bachelor of Social Work Program.
Yes
No
I agree to comply with all University of Arkansas at Little Rock and Bachelor of Social Work policies and I am aware
that violations of policies will be addressed in accordance with university and program policies.
Yes
No
Signature:
Date:
Please continue to Page 4.
Footnotes are detailed in the application instructions document.
Rev June 2014: SCT
University of Arkansas Bachelor of Social Work Program Application
Page 4 of 4
Please type all responses to the below questions, save as a word document, print, and submit to the BSW
Program with your other application materials. See application instructions at
http://ualr.edu/bsw/index.php/home/admissions-info/ .
In a separate word document of no more than 3 pages, please write a personal statement that includes the
following:
1)
A description of your understanding of social work and the important events or experiences in your life
that have contributed to your decision to select social work as your major and your profession;
2)
A brief example of a situation in which you had to make a difficult decision/judgment. What were your
considerations in making this decision? What was the outcome? What would you change if you could
do it again?; and,
3)
A presentation of the characteristics that you would bring to the social work program. Specifically,
identify three strengths that you bring to the program that may not be reflected in other areas of the
application. Then, identify three challenges that you may encounter in this program and how you would
address these.
In evaluating your answers, we will be looking for the following:

Thoroughness and organization of your responses;

An understanding of social work and evidence of emotional and professional readiness to enter the
profession;

Writing ability: Use of standard English, clarity in presentation, and writing free of errors in grammar,
style, and syntax.
Include the statement below in your submission of these materials to the UALR BSW program.
By signing below, I certify that the statement presented above is completely original and truthful. I certify that I
am the sole author of this statement. I also acknowledge that submitting work other than my own work may
result in the application being denied and/or dismissal from the University of Arkansas at Little Rock Bachelor
of Social Work Program.
Signature
Footnotes are detailed in the application instructions document.
Rev June 2014: SCT
Date