Note: Before filling out the form, please upload a copy of your updated resume.

One file only.
100 MB limit.
Allowed types: pdf, doc, docx.

Program Status

Notes:
1. Advanced Standing is only for those who have a Bachelors of Social Work.
2. The modified program for students with non-standard schedules may include weekday/weekend combined, extended, or transfer credits.

Class location
Student category
Class days
Class year
Placement Information (select all that apply)
Which possibilities are you submitting information for? (check all that apply)

Student Contact Information

Current Address
Will this address be valid during the summer and the coming academic year?
If not, please provide an alternate address.
Alternate Address
Do you have a valid driver's license?
Will you use a reliable, insured vehicle for transportation to your placement?
For current students only: Indicate how you communicated with your faculty advisor to inform them of the information you are submitting
Note that both incoming and advanced standing students may disregard this question. 

The Department of Graduate Social Work has relationships with agencies throughout New England and New York. Assignments are made based on opportunities for students to develop advanced generalist skills, appropriate supervisory personnel, and expertise at the site, as well as availability at the agency. Each year presents different opportunities at the agencies with which the school partners.

Possibility A

Possibility A: Department of Graduate Social Work Assigned Placement

What age population are you MOST interested in working with?
What age population is your SECOND choice?
What age population is your THIRD choice?
What services are you MOST interested in learning about?
What services are your SECOND choice to learn about?
What services are your THIRD choice to learn about?


Students: please use the space below to provide additional information about yourself (beyond that indicated by your current resume, which must be attached or provided) that will assist the Office of Field Education in making the field placement assignment (attach additional sheets if needed):

“I will accept an assignment from the MSW program’s agency affiliates.  I understand that I have a maximum of three (3) business days to arrange for an interview with the identified contact person once the placement possibility has been identified (though some agencies may request a shorter time period in which to schedule the interview).  I understand that interviews for field placements are highly competitive; I will prepare for my interview as I would for a job interview, providing the interviewer or contact with a cover letter as needed and an updated resume in advance of the interview, researching the services of the agency, preparing relevant questions for the interview, and sending a thank you message following the conclusion of the interview. Before, during, and after the interview I will maintain professional decorum in all my interactions with agency representatives, including dressing professionally for the in-person interviews and any follow-up interviews.  I understand that after two field placement assignments are made that do not result in a definitive placement, my name may be referred to the Field Placement Advisory Committee for determination of next steps in the field placement assignment process.”

Possibility B

Possibility B: Employment-Based Placement

To be completed in consultation with appropriate and authorized representatives from the student’s place of employment. The following questions must be completed before submitting to the Office of Field Education.

The supervisor should have:

  •  an MSW
  •  a minimum of two years post-MSW experience
  •  be someone other than the student’s employment supervisor

(Professional social work licensure is strongly preferred for supervisors of first year placements, and previous participation or willingness to participate in the Seminar in Field Instruction for new supervisors is highly encouraged. Second year placements in Massachusetts require a supervisor with an LCSW or LICSW and second year placements in Connecticut require a supervisor with an LCSW. The Office of Field Education reserves the right to make exceptions to requirements on a case-by-case as needed in accordance with current CSWE and state licensing guidelines.)

Address of Location of Placement
(e.g., services provided, population served, which department or program you will be assigned to). 

Note: Activities should be substantially different from those in current employment settings and must reflect MSW-level responsibilities with a focus on continued and deepened learning, and meet the schools' curricular requirements.

Please estimate your scheduling availability for your placement. Note that many placements require availability on certain days or times and most sites require availability during the day, during the week.

First year placement: 15 hours/week, 225 hours/semester, 450 total hours required.
Second year placement, including advanced standing: 20 hours/week, 300 hours/semester, 600 total hours.
 
(include a brief description; attach additional pages if needed)
(provide a brief description; attach additional pages if needed)
Community is for first placements, and Administrative is for second placements. Provide a brief description; attach additional pages if needed.

Option 1: “I have discussed the following employment-based practicum proposal with agency supervisors and representatives and it has received preliminary approval. I have also discussed this plan with my faculty advisor. I am aware that final approval rests with the professional staff of the Office of Field Education based on supervisory criteria and appropriate opportunities for learning.”

Option 2: “I have investigated the possibility of an employment-based practicum and I will continue to discuss this possibility with supervisors and representatives at the agency in which I am employed until a decision is reached that provides full learning opportunities. I understand that my agency of employment will be reviewed for practicum suitability by the professional staff of the Office of Field Education. If it is determined that my place of employment cannot provide the appropriate internship opportunities, I will work with the staff of the Office of Field Education to secure an internship that meets required curricular criteria.”

Please select an Option that your initials indicate that you have read and agree with.
Possibility C

Possibility C: Possible New Agency Suggestion

While the Department of Graduate Social Work has established relationships with approximately 450 agencies across New England and New York State, there may still be agencies about which we are not familiar or that have been newly established. If you suggest an agency with which we already have a relationship, we may work through our contacts there. Or, if you provide contact information that is new to us, we will likely work through your suggested contact. 

Address of Suggested Agency


For the following questions, it should be your understanding that the suggested agency serves this population -- do not choose a population that the agency does not serve.

What age population are you MOST interested in working with?
What age population is your SECOND choice?
What age population is your THIRD choice?


For the following questions, it should be your understanding that the suggested agency provides these services -- do not choose a service the agency does not offer.

What services are you MOST interested in learning about?
What services are your SECOND choice to learn about?
What services are your THIRD choice to learn about?


Students: please use the space below to provide additional information.


“I have suggested what I believe is a placement agency or program that is new to the MSW program to be researched by the Office of Field Education for placement suitability. I understand that the suggested agency may not be approved as a placement based on supervisory and curricular expectations or availability of placements there. If the agency I have suggested is not approved, or does not have availability, I will accept an assignment from among the MSW Program’s agency affiliates or I will investigate an employment-based internship along with assistance from the professional staff of the Office of Field Education.”