Social Work
Name:*
Your Telephone Number:*
E-mail Address:*
Agency Name:*
Agency Address/City/State/Zip:*
Agency Telephone Number:*
Licensed Social Worker: Yes No Pending
Type of Licensure: LSW LGSW LISW LICSW Other
Number of Years as a Field Instructor for Bethel University:
Number of Years as a Field Instructor for other Social Work Programs:
I have attended a course or workshop on supervision/field instruction within the past two years:
Since 1982 the Council on Social Work Education has accredited this BSW program. We must ensure that our field instructors meet the following basic requirements:
* Hold a CSWE-accredited baccalaureate or master's social work degree (including Foreign Equivalancy).
* Minimum of one-year social work experience after graduation
As field instructor, I plan to carry out the following responsibilities:
* Attend an orientation for field instructors at the beginning of the field practicum.
* Provide an orientation to the agency and student's job responsibilities.
* Providing suitable workspace, desk, phone and support services needed to carry out assigned tasks.
* Provide weekly supervision to the student for evaluative feedback and serve in an educational role.
* Advise the student during formulation of the learning contract.
* Arrange assignments which offer meaningful learning experiences and increase in responsiblity according to student's progress.
* Participate in three-way conferences with student and faculty liasion, usually two to three per school year.
* Complete Student Performance Evaluation Form at the end of each term and sign timesheets.
* Attend seminars and workshops with other field instructors and faculty liaison as arranged during the school year.
* Communicate with the faculty liaison whenever a question, misunderstanding, or problem develops.
Your name and submission of this form confirms your committment to provide field education. Thank You.
Date:*
