East Carolina University School of Social Work
BSW Field Education Application Information
The Field Education Office coordinates the placement process for all students; students are not to secure their own
internships. The process for placement begins in the semester prior to beginning field and includes submitting a field
application, an interview with field staff, and an agency interview. BSW students are typically in field Tuesday through
Friday. During your field placement you will attend a field seminar which will meet on Mondays. More information on
Field Education is available on the field website: http://www.ecu.edu/cs-hhp/socw/field-education.cfm .
Applying for Field Education
You must have completed all required social work courses and have a minimum of 2.5 GPA before you can enter field.
You will need to register for the field seminar course (SOCW 4990) and submit a completed field application including all
attachments. When you submit your completed application to the field office you will then schedule an interview with
the field staff. Be prepared to discuss your interests and any information that might affect your placement or
performance in field during this interview.
East Carolina University seeks to comply fully with the Americans with Disabilities Act of 1990 (ADA). Students requesting
accommodations based on a disability must be registered with the Department for Disability Support Services located in
Slay 138 [(252) 737-1016 (Voice/TTY)]. Please make the field office staff aware of any requested accommodations.
Field placements will be within a 60-mile radius of the school. It is the student’s responsibility to provide reliable
transportation to the agency. Students should possess a valid driver’s license with appropriate automobile insurance
coverage.
Field agencies may require a criminal background check, drug screening, and/or specific vaccinations prior to accepting a
student as an intern. Field agencies may also check with registries such as the Child Abuse Registry, Elder Abuse Registry,
Healthcare Registry and Sex Offender Registry. The student may be responsible for paying for these. Agencies make the
decision about whether information discovered in the course of the background check will affect the acceptance or
rejection of the student for an internship within the agency.
All students entering field are required to take the HIPAA training course on Blackboard. You will receive an email
notifying you that you have been registered for this course. You will need to complete the online course with a passing
score.
The Application Process
Students are required to submit a completed electronic form of the BSW Field Education Application to
SWFIELD@ECU.EDU , by the announced deadline. It is the student’s responsibility to apply for their field experience by
the stated deadline. Students missing the stated deadlines may be delayed in entering field or may have to postpone
their field placement for a later semester. A complete application for Field includes: the Field application form, a
current picture and a copy of your current resume. The semester before your internship the Field faculty will visit your
classes and provide additional information on how to complete the field application.
When you submit your completed electronic form of the Field Application to the Field Office, you will be contacted by
your assigned field placement coordinator to schedule an individual interview. Be prepared to discuss your learning
needs and placement possibilities. If you have any questions or concerns about the application process for your BSW
field assignment, please contact the Field Education Office at 328-4383.
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Student Internship Agreement
Please read the following agreement carefully before signing. You will be held accountable for these
responsibilities and information. You will not be eligible to enter field until you have signed the agreement
and initialed each item. If you have questions about any item, please discuss it during your interview with the
Field Office.
By signing this agreement, I agree to the responsibilities and guidelines listed below. I also agree to take
responsibility to know and adhere to field policies and procedures. I give my written consent to the School
of Social Work at ECU to disclose information from my education records to the internship agency as
required by the School for placement in an internship.
I understand that any violations of this agreement can result in my removal from the internship, and may
affect my ability to complete the BSW program.
Student signature
Date
As an applicant for Field Education, I agree to the following (initial each item on the line):
_____ 1.To act professionally and ethically. This includes, but is not limited to, adhering to the Code of Ethics of
the National Association of Social Workers, maintaining confidentiality, and giving priority to the rights and
needs of clients over my own.
_____ 2. To adhere to the ECU Student Code of Conduct. This includes refraining from use of alcohol or drugs and
other behaviors restricted by the Code. I understand that a positive drug screening will make me ineligible
for field.
_____ 3. To disclose fully and honestly the information requested by the Field Office.
_____ 4. To follow the policies, procedures, programs and operating standards of the placement agency.
_____ 5. To authorize the School of Social Work faculty to discuss my learning needs, progress and other
information relevant to my internship with other faculty members, Field Instructors, Task Supervisor and
agency contact persons as they deem necessary.
_____ 6. If my field work or professional development is not deemed satisfactory by social work faculty, agency, or
me, either party has the right and the responsibility to request reassessment of my suitability to continue in
the field.
_____ 7. Prior to beginning my internship I will read the Field Manual and be responsible for understanding the
information it contains. I will be familiar with all field guidelines, policies and procedures, including:
 Process for securing a field placement
 Attendance policies
 Evaluation and grading
 Procedures for problems solving, including grievances, requesting changes and
terminations in field
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ECU School of Social Work
BSW Field Education Application
Please complete provide all information required on this application and sign the verification statement. If you have any
questions about an item on the application, please contact the Office of Field Education at 252-328-4383.
My signature below signifies that all information on this application is true and valid. I understand that providing
incomplete or false information can make me ineligible for a field internship.
Student signature
Date
1. Name:
__
Banner ID number (required) ____________________________
Phone: (
)
_______
Date:
Overall GPA (most recent)
Alternate Phone: (
)
ECU Email address:
2. Your Address While Attending ECU:
City
State
Zip
State
Zip
3. Permanent Home Address (if different from above):
City
4. Where will you reside during placement?
5. Are you bilingual? Yes
University
Home
No
If yes, which language(s)
Proficiency Level:
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beginner
intermediate
advanced
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6. Do you have a valid driver’s license?
Yes
No
All students must arrange their own transportation to field agencies. Will you have a car available for
transportation? Yes___
No____
If no, how will you arrange for transportation? __________________________________________________
_________________________________________________________________________________________
7. List 3 counties, in order of preference, for your field placement site. Please note that every effort is made to
accommodate student preferences, but location cannot be guaranteed.
1.
2.
3.
8. Students requesting accommodations based on a disability must be registered with the Department for Disability
Support Services located in Slay 138, (252)-737-1016 (Voice/TTY). Students who are requesting accommodations
must submit a copy of their accommodation letter to the Field Office.
Are you requesting any accommodation under the Americans with Disabilities Act of 1990 (ADA)?
Yes
No
9. Dual Roles/ Conflict of Interest
Previous experiences, dual roles or potential conflicts of interest can affect the suitability of certain internship
placements or a student’s performance in field. While these do not necessarily rule out a placement, the Field
Office must have this information prior to beginning the placement process to help ensure appropriate placements.
The Field Office will also help you determine how to present such issues during agency interviews.
If you are unsure about an item, please include it and discuss it during your Field Office interview. The following
questions are to assist this discussion; however there may be other issues that should be considered. Students are
responsible for making the Field Office aware of any experiences that could impact your internship placement.
a. Are you or a close family member receiving (or have you received) services from an agency that could become a
potential internship for you? Yes
No
b. Do you have any family members or close friends employed by any agencies that could become a potential
internship for you? Yes
No
c. Are there any issues that might affect your functioning in your internship? For example, a recent death in the
family, a recent significant life event, issues that may have required counseling, etc. Yes
No
d. Are there any other issues that might affect your performance or placement in field?
Yes
No
10. Have you had any legal involvement? This includes, but is not limited to, drug or alcohol related charges, bad
checks, traffic violations, speeding, shoplifting, assault, verbal or cyber threats, etc. Yes
No
Have you ever been convicted of a felony? Yes
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No
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11. Do you anticipate being employed part-time during the field placement? Yes ____ No ____
If yes, how many hours per week do you anticipate working? ___________
If yes, write a brief description of how you plan to balance the requirements of field placement and course work
with the requirements of your paid work.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
***The questions below will provide the field office with information on your individual interests and career goals. Every
effort is made to match the student to a field placement that meets their interests. However, please be aware that there
is no guarantee that students will be able to be placed in specific agency or service area. This is due to educational
standards, the voluntary nature of Field Instructors and the limits of community resources. It is important for students to
be open to a variety placement options and service areas***
12. What populations are you most interested in working with during your field placement? Check all that apply
□Children
□Adolescents
□Adult
□Elderly
□Families
13. Please check practice areas you would consider for your placement. Check 3-5 items, then rank the items you
checked in order of preference. (For example, put a 1 next to your first choice, a 2 next to your second choice, etc.)
□After-school/ Youth Programs
□Child Abuse
□Child Welfare (CPS, foster care& adoptions) – Note: Students must be accepted into the NC Child Welfare
Education Collaborative to be placed in a DSS Child Welfare internship.
□Court Involved Clients
□Developmental/Intellectual disabilities
□Domestic Violence
□Aging/Adult Protective Services
□Emergency Assistance/Poverty
□Homelessness/Housing Assistance
□Hospice
□Macro Practice/Administrative
□Medical/Health
□Mental Health (day treatment, case mgmt.)
□Physical disabilities
□Residential care (24 hour care facility)
□School
□Substance abuse
□Unemployed/Job skills/Job readiness
□Other __________________________
14. What activities interest you the most? Check all that apply
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□Advocacy
□Assessment
□Case Management
□Community Outreach
□Conflict Resolution
□Crisis Intervention
□Discharge Planning
□Documentation
□Education/Prevention
□Grant Writing
□Home Visits
□Referrals
□Policy
□Other______________________________________
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15. Are you applying for any of the optional certificates? Yes/No (please circle)
If you circled yes, please indicate below which certificate you would like to pursue:
□
□
Child Welfare Collaborative
School Social Work
16. Do you want to be considered for internship placement at your place of work? Yes/No (please circle)
To be considered, you must already be employed at a human service organization. See the ECU School of Social Work
field manual for further details.
If you circled yes, please list the name of the agency where you are employed:
________________________________________________________________________
18. What do you consider to be your strengths?
19. What do you hope to learn from your internship? What skills do you want to develop?
Please take a moment to review the checklist below to see if you have a completed packet:



An application complete with your signatures
A copy of your current resume
A current photo of yourself
For Field Office use only:
Complete application received from student by:
Field staff signature
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Date
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