Recruitment Guide

Please don't use this field.
Agency Name:
Address:
City:
State:
Zipcode:
Telephone:
Fax:
Contact Person:
E-mail:
Check here if no changes are necessary
(The contact person is the gatekeeper of all student placements, not necessarily the field instructor)
Name(s) of MSW Field Instructor(s):

Telephone:
E-mail:
Name(s) of consultant MSW Field Instructor(s):

Telephone:
E-mail:
Name(s) of Non-MSW On Site Field Instructor(s):



Telephone:
E-mail:
* Note: all students are required to receive 1 hour per week of supervision from an MSW.

Note: students can receive on-site supervision by a non-MSW in addition to the MSW supervision.

Placement Levels

(please indicate how many students of each level your agency can accommodate)
BSW
MSW I - Generalist
MSW II - Administration
MSW II - Clinical
MSW II - Policy
MSW II - Dual
Total (Add all levels)

PART 2

1.Do you offer any financial assistance (stipend, salary, grant award, etc.) to student interns in you agency? Yes
No
If yes, amount & conditions:
2.Do you have hours available to students on evenings and weekends? Yes
No
If yes, please indicate what hours are available:
3. Is a car required to perform the duties associated with placement? Yes
No
If yes, do you reimburse for mileage? Yes
No
If yes, does the agency provide a car/van to transport? Yes
No
If yes, does the agency provide insurance coverage? Yes
No
4. Are there any screenings that must take place before students are cleared to begin a field internship (BCI, CORI, TB test, etc.)? Yes
No
If yes, what screening(s):
Check all that apply to the following questions:
5. Your agency type is: Public/non-profit
Private/non-profit (501(c)3)
Private/for profit
6. Your agency setting is: Residential
Community Based
Inpatient
Outpatient
Other
7. Your client population is: Children
Adolescents
Adults
Older Adults
Female
Male
8. Modalities include working with: Individuals
Families
Groups
Communities
Organizations
Legislature
Professional Coalitions
9. Your program & service offerings include: Administrative Issues
Adoption
Advocacy
Community Organizing
Corrections
Counseling
Crisis Intervention
Education
Evaluation
Foster Care
Grant Writing
Healthcare
Homelessness
Hospice
Housing
Legal
Legislative Work
Mental Health
Planning
Policy
Poverty Issues
Program Development
Rehabilitation
Substance Abuse
Other:
Brief description of program(s) in which students may be placed:
10. Does your agency have accreditation by any certifying organization(s)? Yes
No
If yes, name the certifying organization(s) and date(s) of certification:

Page last updated: October 4, 2012