C-04 Application Form for Attachment Placement
The University of Hong Kong
Department of Social Work & Social Administration
Social Work Fieldwork Placement
Application Form for Attachment Placement
Upon the consent of employing agency, MSWPT student can apply for taking the placement in the serving agency as
attachment placement. (For details, please refer to http://placement.socialwork.hku.hk FQA – Q3). Please consult
the agency supervisor to seek consent on such arrangement and then provide the information as follows:Name of Student:
UID:
Program of Study: (FT/PT BSW/MSW)*
Mobile No.:
HKU Email Address:
For PT MSW students, please indicate the placement for applying attachment placement.
□SOWK6225 in the 2nd year
□SOWK6231 in the 3rd year
Information of the Attached Placement:
Name of the Centre:
Name of the Agency:
Name of your Immediate Supervisor: (Mr./Ms) :___________________________________________________
Post Title:_________________________________________________________________________________
Office Tel. No.:
Email Address:
Correspondence Address:
Nature of Placement Settings (ie. Youth, Elderly, Rehab.):___________________________________________
Type of Agency Sponsorship:
full
fractional (please specify hours):_________
No special leave being granted
To be confirmed
Information of Other Person(s) the Department Should Inform about the Placement Details:
1. Name:
(Mr./Ms)
Office Tel. No.:
Post Title:
Email Address:
Correspondence Address:
2. Name:
(Mr./Ms)
Office Tel. No.:
Post Title:
Email Address:
Correspondence Address:
Signature of the Applicant:
* Please delete as appropriate
Date: