School of Social
Work
San Diego State University
School of Social Work Field Education
MSW II – Advanced Field Practicum
Information and Application Packet
SW 750 & SW 755 Courses for
Academic Year 2014-15
*This information /application packet is only for social work graduate students who will have completed SW
650 Field Practicum by May 2014 and who are entering the MSW II Advanced Field Practicum SW 750 or
SW 755 in the Fall 2014.
For further information please refer to SDSU School of Social work Web Site, Field Education FAQ’s at
http://socialwork.sdsu.edu/field/faq.php
MSW II Field Advanced Field Application Form is to be completed on IPT by
Monday February 10th 2014.
A hard copy of the first page of the Field Application or “face sheet” is to be turned in to School of
Social Work, Main Office (HH-119) by Wednesday January 29th, 2014
This “face sheet” can be found at http://socialwork.sdsu.edu/field/student-forms/ and is labeled “MSW II
Field Application Face Sheet” and must be complete by all students who plan to begin Advanced Year
Field Practicum (SW 750/755) in the Fall 2014 Semester. The majority of students will have an existing
IPT account from SW 650, but we need to cross check for updated contact information, identify students
who are changing to 4 year program, hence we need the one page “face sheet.”
MEMO:
Date:
January 10th 2014
To:
Prospective Advanced Field Practicum Students enrolling in SW 750 or SW 755 in Fall 2014
From:
Candy Elson, LCSW. Director of Field Education and Field Faculty Team
Re:
MSW II Advanced Field Practicum Application and Placement Planning Materials,
Field Placement Process, Policies and Procedures
Welcome Back for the Spring Semester 2014!
The placement process for your SW 750 and SW 755 Field Practicum will begin this Spring Semester (as soon as you
return to School). We have 300 undergrad and graduate students to place in quality field placements for Fall 2014, so the
process starts now, nine months in advance.
Enclosed please find:
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SW 750/755 Field Placement Guidelines - Process - Policies & Procedures
Sample SW 750/755 Field Practicum Application to be completed via IPT via “forms” will be
available on IPT after the Agency Fair, January 31st.
Sample SW 750/755 one page “face sheet” to be completed and turned into SW Office
Internship Questions for Agencies
SW 750/755 Field Practicum Student Agreement
SW 750/755 Field Practicum Checklist
SW 750/755 Field Application is to be completed via your IPT account under “FORMS”. If you are a four year or transfer
student and do not have an IPT account yet – please contact swfield@mail.sdsu.edu to request an account. You will need
to submit a field application “face sheet”, described below, found at http://socialwork.sdsu.edu/field/student-forms/ and is
labeled “MSW II Field Application Face Sheet”
In addition to completing the full 750/755 Field Application on line via your IPT account, we are also need a hard copy of
the first page, “face sheet” of your application so field faculty and administrative staff can track completion of field
applications. We are not ready to go 100% paper-less and need the paper “face sheet” to be turned in to the social work
office on Wednesday January 29th, 2014.
This “face sheet” can be found at http://socialwork.sdsu.edu/field/student-forms/ and is labeled “MSW II Field
Application Face Sheet” and must be complete by all students who plan to begin Advanced Year Field Practicum (SW
750/755) in Fall 2014.
Please check that you have all the materials mentioned above & make sure you review the Social Work Graduate FAQ’s
listed on the website.
The enclosed materials will outline the process/procedures you must follow and complete in order to be placed for your
field practicum internship and to register for SW 750/755 in the Fall Semester, 2014. Please be aware of all of the
guidelines, instructions and due dates.
After you review all of the materials carefully, attend the Placement Planning Meeting and the Agency Fair, you will
be ready to begin selecting your advanced field practicum agency for your second year internship. You can review all
available agencies via your IPT account. All agencies should have a brief description of the agency and the internship
experience although all agencies have not up-dated their accounts. Students will also be provided a separate
current list of available agencies for Fall 2014 prior to the Agency Fair, via email. Be aware that not all eligible
agencies attend the Fair.
Please ensure that you complete the SW 750/755 Application in its entirety before signing & submitting it by the due
date of February 10th, 2014 via IPT.
Attending the Agency Fair on January 31st, 2014, 9:00 am to 12:00 noon, Jacobs Center, 404, Euclid Ave. San
Diego CA 92114will also help you make your decision. You will have a chance to talk to agency representatives
and current interns.
Thank you for your time and attention.
Candy Elson LCSW and the Field Faculty
San Diego State University - School of Social Work
SW 750/755 Advanced Field Placement Process - How you choose your 2nd year agency & maximize your chances of
obtaining your first choice. It is a competitive process.
School of Social Work Policies and Process
The selection of your SW 750/755 Advanced Field Experience Placement is a collaborative process, involving the
Student, Field Education Faculty, the Field Experience Agency, and the Field Instructor. This process usually begins
the second week of the Spring Semester and involves the following components, described in detail in this memo:
1) Attending the Prospective 750/755 Field Placement Planning Meeting, January 24th, 9:00 to 11:00am
2) Completing Field Application one page “face sheet” (due Friday February 1 hard copy to SW Office)
& complete the entire SW 750/755 Field Application and submitting it by February 4th, 2013. The
application can be found under “forms” in your IPT account.
https://www.alceasoftware.com/web/login.php
3) Attending the 2013 Agency Fair
4) Completing the Agency Referral Process and Interview.
5) Receiving confirmation of placement from Field Faculty by E-Mail and/or phone.
6) Timely completion of all requested background screenings.
PROCESS STEPS:
1.
Prospective 750/755 Field Placement Planning & Information Meeting& Agency Fair:
Each student who is eligible for his/her MSW II Advanced Field Practicum Internship for the following Fall Semester
shall attend the Internship Placement Planning informational meeting scheduled for January 18th, 2013 and Agency Fair
scheduled for January 25th, 2013 in order to obtain information regarding the field placement process, have
questions/concerns answered, etc. The Placement Planning Meeting will be held on Friday January 18th, 2013, 2:00 pm to
3:30 pm at the Health Services Complex, 3851, Rosecrans Street, San Diego CA 92110 (Coronado Room) near the Old
Town Trolley if you are taking public transport. The Agency Fair is being held the Jacobs Center, 9:00 am to 12 noon,
404, Euclid Avenue, San Diego CA 92114.
750/755 Course Eligibility: In order for a student to be eligible for SW 750/755 Advanced Field Practicum course he/she
must follow the school’s procedures and policies for field internship referral, pass the interview with the agency, and be
confirmed by the agency, including their additional background screening criteria which may entail additional screenings
for health, drugs, criminal background etc. Please be aware that there is often a fee for the agency screenings. Some
agencies pay for intern’s screenings but many do not. Fees can be up to $300 or more and must be paid by the
student. The School is not responsible for this cost.
Eligible students must have passed the course pre-requisites, i.e. SW 650, SW 630, 631, 632, School of Social Work
Qualifying Exam and be in compliance with all school policies.
2.
Advanced Field Practicum Application Packet and Face Sheet:
Each potential SW 750/755 student is required to complete 1. A one page Field Application “face sheet” found at
http://socialwork.sdsu.edu/field/student-forms/ and turn in a hard copy to the School of Social Work office by Friday
February 1st, and complete the "MSW II Advanced Field Practicum SW 750/755 Field Application via their IPT account
due by Monday February 4th, 2013.
Please review each section of the application and insure that the following items are completed:
 The Field Application, plus resume completed to send to your potential field agency
 Passport photo uploaded to your IPT home page
 Student Agreement – signed and dated;
IMPORTANT: Failure to complete any items in the application packet and/or to hand in all the necessary materials shall
delay your field placement opportunities and/or shall delay entering the SW 750/755 Field Practicum.
Please utilize the attached Field Experience Document Checklist that provides guidelines to what must be in your Field
Application Packet.
Field placement agencies may request a copy of your Field Practicum Application Packet, in addition to your resume. It is
possible to print a copy of your IPT Field Application if your agency requests a copy for your interview.
3.
Placement Selection and Referral Process:
Concentration Areas – Choosing Direct Practice (SW 750) or Administration/Community Development (SW 755):
2nd year students are required to declare a concentration in Direct Practice or Administration/Community Development.
Students may review the Agency Lists via IPT and a list of agencies will be sent to students prior to the Agency Fair.
Further information about the Admin/CD concentration will be discussed further at the Placement Planning Meeting on
January 24th, 2014. Students may also individually consult with Marci Siegel or Dr. Tom Packard (Admin) or Ms. Jessica
Robinson (Community Development concentration) to find out more about the Admin/CD concentration. Students may
also review curriculum requirements of both concentrations on the school of social work web site:
http://socialwork.sdsu.edu/field/prospective/curriculum-requirements/
Students can also consult with current SW 755
students via Communications Central.
MSW II Advanced year students are permitted to request or select three specific agencies; however, the placement process
takes your educational and experiential needs, goals, objectives, and preferences into consideration and you may be in
competition with other students for placement sites. We will do our best to meet your request but students must realize that
not all who apply to agencies will be selected to their first choice in field placements.
Students are strongly encouraged to attend the 2014 Agency Fair that is scheduled to be held on January 31, 2014
at The Jacobs Center, 404 Euclid Avenue, San Diego CA 92114, from 9AM-12PM.
Please Note:
As the Field Experience Application Packet is the ONLY means by which Field Education Faculty can identify your
needs, please complete these forms thoughtfully, specifying any special accommodations, restrictions, physical limitations,
problems/concerns, as well as geographic preferences. Field Agencies may request a copy of your resume, SW 650
Practicum Field Evaluation and / or professional references. Be prepared with names of references or your SW 650 Comp
Skills Evaluation. Some agencies may also request a writing sample, so be ready to send a school paper or any other
example of a professional writing sample.
After reviewing all completed applications, the Field Education Faculty will begin the placement process by contacting
field placement agencies in early February. PLEASE DO NOT contact any agency on your own without a direct
referral from the Field Education Faculty. We also request that Agencies do not contact the student independently,
without a referral from the school.
a) When an agency agrees to interview the student, the Field Education Faculty will make a referral to the
student.
b) The referral will be made by E-mail.
c) You are responsible for calling or emailing to arrange an interview with the agency contact person immediately.
Delay in contacting the prospective field experience agency immediately can result in a loss of opportunity or
interview. Long delays in setting up an interview could result in the agency filling up their internship slots before
you have a chance to interview! Please be as flexible as possible in being available for an interview.
d) For the interview, the agency representative will expect to review a copy of your entire SW 750/755 Field
Practicum Application Packet and a resume. A resume should be a brief summary of your paid work, unpaid
work or volunteer experience, education and training. It should also highlight the special skills, achievements,
experiences, knowledge and potential that you would bring to an undergraduate social work internship. SDSU
Career Services are available to assist and review resumes. http://career.sdsu.edu/
As part of the interview process and in order to be confirmed at the SW 750/755 Field Experience, agencies
may request at your expense additional screenings, e.g. random drug screenings; health examination;
verification of immunizations; TB test; security evaluations; fingerprinting, DMV validation of driver’s
license; etc. In addition, agencies may require random drug screening at any time during the year. These
background checks CAN be costly at some agencies, so be prepared to bear the cost of these screenings,
which can be up to $300. (Some agencies pay for the background screening for their interns/volunteers,
but may do not.) If you cannot afford any additional expenses, make this clear in the “comments”
section of your field application.
IMPORTANT: The student is not considered confirmed until he/she passes the required screenings
requested by the agency. If the student fails these screenings, the Field Education Faculty will review the
student’s circumstances. Depending on the time frame and the professionalism demonstrated, the outcome
may result in the student being placed in another agency, becoming ineligible for field experience at this time,
and delayed placement for an entire academic year. Some agencies review student legal activities and request
additional screenings throughout the field experience.
Please note: Students who have misdemeanor and/or felony convictions may not be eligible for
placement in certain agencies, and may be delayed from beginning their SW 750/755 course.
e) All Student and Agency schedules need to be discussed at time of interview. Students are required to defer
vacations so they are not absent from field experience when school is in session. Students are required to be in
their Field placements from the first week of school until the end of Spring 2015 semester. When arranging the
internship schedule with the agency, the student and agency must follow School Policy, which states that an
intern’s schedule in the Field is the responsibility of the student and the agency. Priority in scheduling is
given, in order, to 1) social work-on campus classes, 2) SW 750/755 Field Practicum Course, 3) student’s
other life responsibilities.
Field Instructors cannot waive School Policy. If the agency has specific scheduling requirements, such as staff
meetings, case conferences, etc., the student should register for social work class sections that do not conflict
with Field if at all possible. The student CANNOT ask the agency to arrange the internship around the
student’s other responsibilities, such as employment or childcare.
________________________________________________________________________________
Winter Break should be discussed at the interview. Most 2nd year agencies will request students to put in some time
during the Winter Intercession, (as a volunteer, not an intern, i.e. these hours do not “count” towards your internship
when school is not in session) for purposes of continuity with your clients. During the Winter Break, you are
considered a volunteer and although you are still covered under SDSU’s liability insurance. Students should not
volunteer at the agency during finals week and in addition, the School encourages you have a two-week Winter Break
(which is taken consecutively, in blocks of weeks, not days, and is scheduled by the agency with you). Interns should
establish just what is expected of you, by the agency, during the initial interview and again at the start of the
Fall Semester.
f) Be prepared for the interview process. Remember you are interviewing for a “professional internship.” The
interview is the first, and sometimes the only, opportunity you will have to present yourself to the field
placement agency and to learn about the agency itself. Therefore, arrive with time to spare and dress
appropriately. During this professional encounter you will want to explore how you and the agency would
work together to accomplish your educational goals, while assisting the delivery of services to the agency’s
clients. Issues concerning agency workload, hours, winter break, if driving is required and if mileage reimbursement is provided and other professional expectations should be addressed.
g) The interview is viewed as a competitive interview. You may be competing against other applicants from
SDSU or other schools. If a student does not interview in a professional manner, or if the agency feels the
student lacks skills and experience for a second year placement, they can be can declined by an internship
placement. The student stating, “I am not interested in this particular agency and/or population” or “this was
not the agency that I selected” during the interview process may not receive another referral for placement.
Students who have received (or are receiving) services from the interviewing agency, should notify Field
Faculty before the interview to determine if there is a conflict of interest. The Field Education Faculty will
review the circumstances. Agencies have the right to turn down any student for placement. Please note: Any
information contained in this field experience application and/or any pertinent information relating to your
professional student role shall be discussed between SDSU Faculty and approved field experience agencies
and their representatives. Your signature on the Student Agreement form confirms that you are aware of
this.
4.
Confirmation of Placement:
If you are accepted by the agency, the Field Education Faculty will notify you, either verbally, by phone, and/or e-mail.
(Please make sure the Field Faculty has any changes to your residential address or e-mail address.) If the School has not
notified you of acceptance, the placement is not yet confirmed. If you are not accepted by the first agency with which you
interview, the Field Faculty will meet with you to determine issues, which may have led to you not being accepted. If the
student was declined for competitive reasons or the agency provided relevant feedback, field faculty will consult with the
student to assist them succeed at their next interview. When it is determined that you are appropriate for another interview,
you will be interviewing with another agency following the above process, once again. In accordance with School Policy,
in some circumstances, if an agency denies acceptance to a student for internship, the student can be delayed in field
placement until the following year; and/or can be disqualified for field placement; and will be referred to the Student
Affairs Committee for immediate review. These circumstances are rare.
After you have received confirmation (either by phone, mail, or E-mail) from the Field Education Faculty, call the
agency contact person to confirm your starting date (first week of classes, Fall Semester) and to take care of any
paperwork, screening, or miscellaneous details. It is also a good idea to give the agency your e-mail address,
summer residence address and phone number so they can keep you informed of any changes made prior to your
return to campus in the fall. NOTE – students placed in San Diego County or County contract mental health
agencies, should request to complete Anasazi (electronic medical record training) training during the summer,
prior to starting your internship, if at all possible.
Once a placement is confirmed, agency assignment changes CANNOT be made unless there are emergent issues
and/or problems, which cannot be resolved, and all efforts to resolve them have been exhausted. Changes are made
ONLY through the Field Education Faculty and are not made once the Fall Semester begins. Be sure the Field
Education Faculty knows how to contact you during the summer if any last minute issues arise!
5. Selecting your agency choices. Consultation with faculty and students. Students are encouraged to discuss with faculty
and fellow students the agencies that they know and recommend. Many agencies that accept first year students, (SW 650)
also accept second year students for different responsibilities. Thus students can consult with 2nd year peers. Use field
seminar time or schedule and appointment with your field faculty to discuss agencies and your interests. As noted, it is in
your best interest to attend the Placement Planning Meeting, The Agency Fair, review the Agency Descriptions provided in
IPT and research internship agencies by reviewing their web sites. Since field faculty are confirming new practicum sites
on a daily basis, students have the opportunity to be placed at the newest placements available. It is well worth the time
investment to consult with field faculty. There may be Agencies at the Agency Fair who have a contract with USC but do
not yet have a contract (Service Learning Agreement) with SDSU. If you are interested in a particular agency that does not
have a contract with SDSU, make sure to discuss it with your field faculty. It may or may not be possible to complete a
contract with the particular agency in a short time.
6. Specialized Programs – Placement Selections:
a.
b.
c.
d.
e.
f.
Title IVE Child Welfare Students: Students in this stipend program will receive specialized information from
Ken Nakamura and Silvia Barragan about their 2nd year placement choices. Representatives from Child Welfare
will attend the Agency Fair and you can meet interns and field instructors from the many programs with San
Diego County CWS.
Mental Health Training Program: Applicants to the MHTP program will not know if they have been accepted
into the program before field packets are due on February 10th, 2014. Applicants are encouraged to discuss MHTP
eligible agencies with Candy Elson by email or in person at a scheduled appointment. Applicants should choose
their three top mental health eligible agencies. Applicants may write in a 4th choice, stating, “If I am not accepted
into the MHTP program, I would like to be considered for … specify agency.” Applicants may list one nonMHTP eligible agency as their 4th choice if they wish to.
MSW/MPH Dual Program Students shall make advanced field practicum selections in the
Administration/Community Development Concentration only. Students should note the MPH agencies designated
in the Agency Descriptions and/or consult with Ms. Elson regarding MPH SW 755Admin/CD agency choices.
MSW/JD Joint Program Students can make advanced field practicum selections in direct practice OR
Administration/Community Development Concentrations. These students may wish to meet with Dr Finnegan or
Ms Elson to identify specific MSW/JD direct practice and administration agencies.
Prospective PPS Credential Program Students. Current students interested in the PPS credential are required to
priority select two school districts for their advanced internships. Interested students should meet with Amalia
Hernandez, Ken Nakamura to discuss the PPS program and internship requirements and additional hours and
specific classes.
EC-SEBRIS Certificate Program Early childhood Socio-Emotional and Behavior Regulation Intervention
Specialist Certificate Program. The EC-SEBRIS certificate program is an interdisciplinary program focusing
on professional preparation and skills enhancement of early childhood professionals who work with young
children who demonstrate socio-emotional and behavioral concerns, and their parents. MSW students are now
able to apply to this certificate program. Students who are interested in this certificate program, should meet
with Amalia Hernandez Amalia.Hernandez@mail.sdsu.edu to find out more information. This certificate will
be discussed at the placement planning meeting.
7. Internship at Employment Site Materials. If a student is employed at an SDSU approved advanced field practicum
agency and the agency offers to pay for the student’s internship hours, the student may request to utilize their employment
site for the MSW II Advanced Field Practicum SW 750 or SW 755 course. Students are to download, read and complete
the “Internship at Employment Site Application” and Criteria policies at http://socialwork.sdsu.edu/field/msw.php
Use of employment for field practicum just be in agreement with the School’s policies and procedures and must be preapproved by the Director of Field Education. If there is a possibility of your requesting your employment site as your field
practicum, then place your employment agency as your Number One choice on the Application Sheet and put the letter E
(for employee) after the agency name. You are still required to complete your MSW II Advanced Field Practicum
Application packet by the due date. Please request the additional field application paper work by making an appointment
with the field director, Candy Elson to discuss before the due date, February 10, 2014.
Additional paper work, “Employment Site for Field Practicum Application” is due by March 14th, 2014. Be sure to obtain
additional paper work required from your employer/supervisor well in advance and turn in by the due date.
8. Reasonable Academic Accommodations: When a student is requesting accommodations for his/her internship the
student is required to immediately consult with SDSU Student Disability Services (SDS) office for evaluation, verification
and/or other assistance in the accommodations being requested. In order to assist the student in his/her practicum
confirmation, written accommodations from SDSU SDS must be submitted to Ms Elson by the student ASAP, before
internship interviews begin. The student will be requested to sign a release of information so that the school can consult
with SDSU SDS and the field instructor regarding special accommodations being requested. SDSU SDS can be reached at
619-594-6473 http://www.sa.sdsu.edu/sds/ Calpulli Center, Suite 3100. Please note that the graduate advisor, is available
to expedite a student’s referral to SDSU SDS.
9. Misdemeanor and/or Felony Convictions: Field placements must be planned in accordance with State and Federal laws
and with consideration of field practicum agency policies, including the best interests of clients. Increasingly, human
service agencies are requiring background checks, such as fingerprinting, live scan etc to insure the suitability of students
interning at their agencies. Students who have a history of arrest, criminal charges, and misdemeanor and or felony
convictions may encounter barriers in the field placement process. Review and complete the criminal conviction (s) section
of the Field Application. Students who fail to disclose past criminal convictions and then fail an agency background check
may be administratively ineligible for SW 750/750.
10. Conflict of Interest: The NASW Code of Ethics states that “social workers should be alert to and avoid conflicts of
interest that interfere with the exercise of professional discretion and impartial judgment.” (NASW Code of Ethics, rev.
2008, 1999) As a social work student, it is potentially a conflict of interest to engage in a field practicum in an agency
where you and or a family member have been an client or employee. Thus, a social work student is discouraged from being
placed at an agency where they or a family member have worked, received services such as medical or mental health
services or child welfare services.
Since the school of social work does not ask or obtain such information, it is the responsibility of the student to consult
with field faculty if they believe a there is a potential conflict of interest and they need to decline and internship placement.
The NASW is accepted as part of the School of Social Work’s academic standards and students should be mindful of the
Code and aware of the consequences of violations of the code.
Additional Advanced Field Practicum Information & Policies:
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SW 750/755 Field Experience requires 20 hours per week, for a total of 300 hours each semester for the Academic
Year. All placements are made in San Diego County (in accordance with School policies and procedures).
Requests for placements outside of this area will be considered on a case by case basis by the Field Director who
will ensure the ability to provide quality field education, appropriate monitoring, and professional accountability.
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Transportation: You must show proof of automobile insurance and California Driver’s License upon request
by your agency. Most settings require the use of a car. Students can expect an average driving time of up to 30-
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60minute (each way) between your residence and field practicum site. The hours spent driving to and from your
agency are not included in your field placement hours. Some agencies require travel; please inquire about
reimbursement before the placement is finalized. Not all agencies reimburse for mileage!
Students must be available for placement during usual agency business hours in order to participate in
appropriate experiences and receive proper supervision. Evening and weekend placements are not usually
available; if agency can provide evening or week end hours, the agency is responsible for providing
appropriate supervision during your time at the site. There are a few agencies that provide some evening and
week end hours but at least 8 hours during business hours is usually required.
Your Field Education Faculty seminar assignment will be e-mailed to you. It is your responsibility to check email
to know your assigned Faculty at the beginning of the Fall and Spring Semesters.
Please download a copy of the latest edition of the Social Work Graduate Student Field Manual which will
be available at the end of August on the Field Website. You are responsible for knowing the latest School Policies
and Procedures, new Field Experience Calendars and new Field Evaluations for the next Academic year. Utilizing
outdated Field Experience forms may result in a grade of No Credit. Please refer to the Syllabus.
SW 750/755 Field Experience must be taken concurrently with the specified practice class (SW 744; 739 or SW
740 or SW 745). Please refer to the general catalog, SDSU Class Schedule, and SW Graduate Student Handbook
for further details.
PREPARATION FOR AGENCY FAIR - INTERN QUESTIONS TO CONSIDER:
1. Direct practice vs. Administration/Community Development Concentration?
2. Would you like an inpatient/residential versus an outpatient setting in the community?
3. Office based or opportunity to go into the field and do home visits?
4. What population is being served? Adults/Older Adults? Children Youth and Families?
5. Is the pace fast and unpredictable or steady and predictable? Are you an “adrenalin junkie” or do you find fast
pace stressful?
6. What is a typical case load? What is a day in the life of an intern like?
7. Does the agency offer any evening or week end hours?
8. Are there interns from other schools/disciplines at the agency? Are there current interns at the agency that you can
talk to?
9. Are additional trainings or educational experiences offered?
10. What are the expectations for hours over Winter Recess?
11. Are any stipends available? Is parking or mileage paid for by the agency?
12. Is a second language preferable/needed?
SAMPLE - SAMPLE – SAMPLE – THIS FORM WILL BE LOADED & COMPLETED VIA STUDENTS IPT ACCOUNT.
SDSU School of Social Work ~ Field Education ~ 5500 Campanile Drive ~ San Diego, CA 92182-4119
MSW II Advanced Field Practicum Year Application
(SW 750 / 755 – Advanced Field Practicum Course)
MANDATORY
2014-2015 Academic Year
Upload Passport Type
Photo to IPT account –or
attach to hard copy Face
Sheet
Submit fully completed MSW II Application to VIA your IPT Account by Monday February 10TH, 2014 Page One, “face
sheet” due to social work office by Wednesday January 29th, 2014..
INSTRUCTIONS: TYPE. Complete all sections when completing application on IPT. .
Please complete page one (“face sheet”) of this application, available separately, and turn it in to the Social Work Office by
Wednesday January 29th, 2014. The full application will be completed on line, via your IPT account and is due Monday
February 10th, 2014. We need a hard copy of this page one for tracking purposes and to ensure that all students have an
IPT account
Red ID #:
Date of MSW II Application:
Name:
Date of Birth:
First
Permanent Address:
City:
State:
Telephone (Home):
Gender:
/
/
Last
Zip Code:
Email:
Mobile:
Summer Tel. (If different):
Ethnicity:
Citizenship:
Note: Remember to send address, phone, and email changes during 2014-2015 academic year to: Social Work Field
swfield@mail.sdsu.edu.
MSW Program Information
Concentration:
Administration or Community Organizing
Program Status: Advanced Standing Program
Specialized Programs: Joint MSW/MPH
2 Yr. Program
Joint MSW/JD
Direct Practice
3 Yr. Program
Title IV-E CW
4 Yr. Program
MHTP Applicant
SDSU – MSW I Foundation Year Field Placement:
Focus Area:
Aging
Behavioral Health (MH)
Child Welfare
Student’s Graduate SDSU Cumulative GPA is above 2.85? Yes
Health
No
International
Print out this “face sheet” page only and submit a hard copy to the School of Social Work Office, attention
“Field Education” by Wednesday January 29th, 2014 The full application must be completed on line via your
IPT account by Monday February 10th.
Advanced Field Practicum Selections_______________________________________________________
Please list in order of preference the 3 agencies you have chosen for your Advanced Field Practicum. If you do not
have a preference, please list the types of settings and/or population groups you would like to work with.
Agency Name:
1.
Program:
1.
2.
2.
3.
3.
Transportation_________________________________________________________________________
The student must be able to show proof of adequate automobile insurance, meeting the minimum State of California
requirements, and a valid California Driver’s License upon request from the agency. Most settings require the use of a
car.
Do you have a car?
Yes
No
Language Fluency________________________________________________________________________
Are you fluent in a language other than English?
Total Fluency?
Yes
No
Yes
No
If yes, which one(s)?
Only Conversational Ability?
Yes
No
Academic Accomodations_________________________________________________________________
Students who intend to request academic accommodation for their disabilities are required to contact the Director of
Field Education, via email, immediately (before the interview process) to discuss specific accommodations for which
they have received authorization. When a student is requesting accommodations for his/her internship, the student is
required to automatically consult with SDSU Student Disability Services (SDS) office for evaluation, verification
and/or assistance in accommodations being requested.
In order to assist the student in his/her practicum confirmation, written accommodations from SDSU SDS must be
submitted to Candy Elson by the student before internship interviews are completed. Please contact SDSU Disabled
Student Services at 619.594.6473, http://www.sa.sdsu.edu/sds/, Calpulli Center, Suite 3100. Please note that your
graduate advisor, Dr. Lucinda Rasmussen is available to expedite a student’s referral to SDSU SDS. Please refer to
“Field Placement Process Policy - Special Accommodations Section” in the Field Education Manual for further
details.
Circumstances Regarding Clearances_____________________________________________________
Student interns shall be professional and act in accordance and compliance with the laws, social work values,
ethics, and School academic standards, including the NASW Code of Ethics-1999 revised
(www.socialworkers.org/pubs/code), which govern social work practice. Felony / misdemeanor convictions
depending on the severity, duration, time frame, type, can lead to: an academic year delay in field placement;
immediate field practicum ineligibility; and/or disqualification from the School. Each case is reviewed in relationship
to the requirements of the SDSU School of Social Work policies, curriculum requirements, laws, ethics and values
directing the standards in the social work profession. Misrepresentation and/or omission statements will be
considered for immediate ineligibility for the SDSU SW Field Education courses.
Please complete the following questions:
1. Have you ever been convicted in the U.S. or abroad of a crime that is related to the ethical responsibilities and
standards of a social work professional as described in the NASW Code of Ethics?
Yes
No
2. Have you ever performed an act involving dishonesty, fraud, or deceit in the U.S. or abroad with the intent to benefit
yourself or another, or with the intent to injure another?
Yes
No
3. Have you been convicted of any crime in the U.S. or abroad involving child abuse, elder abuse, domestic violence,
assaultive or abusive issues?
Yes
No
4. Have you ever been ordered to register as a sex offender or the equivalent in the United States or abroad?
Yes
No
5. Have you ever been denied a professional license or had a professional license revoked because of a legal,
professional, or ethical issue?
Yes
No
If you answered “yes” to any of the questions in this section, please provide an explanation: identify the issue(s),
date(s), occurrence(s), place, rehabilitation, restitution, etc. Please attach a separate sheet of paper to address the
above.
NOTE: A field practicum application for a student intern position may be denied on the grounds that the applicant
knowingly made a false statement of fact required to be revealed in this application. Therefore, if you are unsure of
the applicability of a past crime to the ethical responsibilities and standards of a social worker, err on the side of
including the information.
Career Goals_________________________________________________________________________
Briefly describe tentative career goals and areas of special interest.
1.
2.
3.
Educational Summary________________________________________________________________
Undergraduate Degree Major:
Location (City and State or Country):
School:
Graduation Month and Year:
Other Advanced Degree Major:
Location (City and State or Country):
School:
Graduation Month and Year:
Prior Professional Experience__________________________________________________________
List prior human service experience (volunteer, internship, and employment), starting with most recent.
AGENCY/ ADDRESS / PHONE
DATES
FROM
TO
Mo. Yr.
HOURS PER
WEEK
EMPLOYMENT,
INTERNSHIP, OR
VOLUNTEER?
Mo. Yr.
1.
Position / Duties:
AGENCY/ ADDRESS / PHONE
DATES
FROM
TO
Mo. Yr.
Mo. Yr.
HOURS PER
WEEK
EMPLOYMENT,
INTERNSHIP, OR
VOLUNTEER?
HOURS PER
WEEK
EMPLOYMENT,
INTERNSHIP, OR
VOLUNTEER?
2.
Position / Duties:
AGENCY/ ADDRESS / PHONE
DATES
FROM
TO
Mo. Yr.
Mo. Yr.
3.
Position / Duties:
Additional Training___________________________________________________________________
Briefly list any additional training, courses, institutes, workshops, and special learning experiences. Include dates of
attendance.
Additional Information__________________________________________________________________ Optional.
San Diego State University - School of Social Work
MSW II – Advanced Field Practicum (SW 750/755) Student Agreement
2014-2015 Academic Year
The following statements are in accordance with the SDSU School of Social Work’s policies and procedures. For
further detailed information, please refer to the Graduate Student Handbook and the Field Education Manual.
Please read the following statements carefully, and sign at the bottom of the page:
1. Application Verification: I hereby certify that the statements contained in this completed Advanced Field
Practicum Application and any other information included as part of this application and attachments are true and
correct. I agree and understand that any misrepresentation or omission of any material facts on my part may be
cause for delay in field placement, separation from the field practicum, and/or can initiate immediate disciplinary
action, and dismissal from the MSW program.
I hereby give permission to the SDSU School of Social Work, Field Education Program, and its faculty members,
and any of the approved field practicum agencies or field instructors to verify any and all information contained
within this application. This can include contacting former employers, field practicum’s, and/or field instructors,
reviewing graduate school records, etc. Please be advised that if any information should come to our attention,
which can affect your professional student status, and/or internship role and thus the field practicum experience,
the School shall be authorized to assess and discuss the significant information with the appropriate parties.
2. Communication: I understand that any information contained in this field practicum application packet and/or any
pertinent information relating to my professional student role shall be discussed between SDSU Faculty and
approved field practicum agencies and their representatives.
3. Agency Clearance(s): I understand that most field practicum agencies request security background
investigations, fingerprint checks, random drug screens, physical examinations, TB tests, immunization
verification, valid CA driver’s license, etc. as requirements for their placement interview process and for practicum
site confirmation and that I, as the student, will be responsible for said cost of the evaluation. Agencies may also
require random drug screening(s) at any time during the year. I am willing to participate in these additional
screens/evaluations and give permission for the results to be provided to the School when requested. I also
understand that if I fail these screens, I will not be confirmed at the specified agency, can become ineligible for
field practicum, and therefore not be placed for an entire Academic Year. I understand that if during the year I fail
a screening, I will be removed from the agency and not placed in another agency for the remainder of the academic
year. The Director of Field Education and assigned Field Faculty will review my issue to determine whether I am
eligible to continue the program, and if so, the timeline for returning to field. I understand that failing a drug
screen(s) and/or other agency screening may be grounds for disqualification from the MSW Program.
4.
University and SSW Policies: I shall fulfill the responsibilities of the student intern role, be in compliance with
all School Policies and Procedures as outlined in the Field Practicum Application and Placement Policy materials,
the Field Education Manual, the SSW Graduate Student Handbook, and the SDSU Graduate Bulletin. I understand
that SW 750/755 is a year-long course and I will be attending for fall and spring semesters in the academic year.
5. Professional Conduct: At all times, I shall maintain professional conduct in accordance with the School’s
academic standards, i.e., the NASW Code of Ethics, professional social work values, and laws regulating social
work practice.
6. Conflict of Interest: As a social work student, it is considered to be a conflict of interest to engage in a field
practicum in an agency where you and/or a family member have been a CLIENT and/or an EMPLOYEE. Thus,
social work students may not be placed in an agency where they or a family member have worked, gone to school,
or received services such as medical care, mental health services, employment assistance or child welfare services.
I understand that it is my responsibility as a social work student to inform the Field Education Coordinator of a
potential conflict of interest AND to decline a placement in which there is a conflict of interest.
7. Termination: If the situation arises and I need to terminate the internship before fulfilling my internship
commitment, I shall terminate in an appropriate, professional manner as designated by SDSU and assigned agency,
and provide written and verbal notice as required by SDSU and the Agency. I understand that any such
termination will be done only with the written approval of the SDSU SSW and the Agency as outlined in the
manual.
I have reviewed and understand all of the above statements and have agreed to be in compliance with all of the
above, the School Policies and Procedures, the Field Education Manual, the Graduate Student Handbook, and
the NASW Code of Ethics. If I am not in compliance with the School’s policies and procedures, I understand
that I can be considered ineligible for Field Practicum.
Please Print: Last Name:
First Name:
Signature:
Date:
San Diego State University – School of Social Work – Field Education
MSW II Advanced Field Application Due Dates:
Submit hard copy of page one (face sheet) only to School of Social Work Office by
Wednesday January 29th, 2014
Submit completed MSW II - SW 750 / 755 Adv. Field Application in its entirety via your IPT account by Monday
February 10th
Deadline is February 10TH, 2014, 4.30 pm to complete your application via IPT.
MSW II - Advanced Field Practicum Application Checklist
The following is a guide to assist you in completing the Advanced Field Practicum Application Packet.
This sheet is for student’s use. Please do not attach as part of your application.
Have you?
 Completed the entire MSW II - SW 750/755 Application Form, including
___Personal Information
___MSW Program Information
___Advanced Field Practicum Selections
___Applicant Information
___Career Goals
___Educational Summary
___Professional Experience
___Additional Training
___Additional Comments
 Read and electronically signed the MSW II Adv. Field Practicum Student Agreement – last page
 Prepare your professional resume and have your SW 650 Field Comprehensive Skills Evaluation for Fall 2012
available for interview if requested. You can print out the Evaluation on IPT.
MSW II ADVANCED FIELD APPLICATION WILL BE AVAILABLE AS A “FORM” ON YOUR IPT ACCOUNT
AFTER JANUARY 31ST, 2014
Page one Face sheet is also available at http://socialwork.sdsu.edu/field/student-forms /
Students can review agency descriptions via IPT – we will also distribute an up to date list of agencies requesting 2nd
year students for Fall 2014 and which ones are attending the Agency Fair before the date of the Agency Fair.
For further information or questions, please contact your SW 650 field faculty or the Director of Field Education, Candy
Elson (594-5144 or HH-117) during office hours or by e-mail at candy.elson@mail.sdsu.edu