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Angelo State University
Department of Social Work

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MSW Field Education Application Form A

The MSW Field Education is a key component of Angelo State University’s social work program. The application for MSW Field Education, MUST be completed prior to admission into MSW Field Education.

MSW Field Students must submit Application Part A and Application Part B.

Criminal Records and Disclosure
  • Failure to disclose criminal background information in application forms could result in removal from the program or field placement.
  • Disclosing criminal background does not disqualify you from being placed into a field placement. 
  • ASU and the Department of Social Work can not guarantee a field placement. 
  • ASU and the Department of Social Work can not guarantee a licensure upon completion of a MSW Degree. 
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I. Personal Information:

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Will you have transportation during Field Education?*
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Do you speak a foreign language (specify)?*
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Will you work during field education:*
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Name, Phone and Relationship
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II. Volunteer and Work Experience:

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Including name of social service organization, dates of involvement, and types of responsibilities you were involved with:
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(25 MB max)
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Write a one page summary telling the field director why you would be the best candidate for this agency.
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III. Potential Field Education Interest

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Many students have a particular population or setting in which they are interested in gaining experience. Please number your top five areas of interest. Your top area of interest will be #1, your second will be #2, and so forth:.
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Geographic Preferences for Field Education Placement:*
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Please provide any additional information that would be helpful in making your field education placement assignment (i.e., employment during semester, travel, financial limitations, etc.):
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FEEL FREE TO LIST BELOW ANY AGENCIES IN WHICH YOU HAVE AN INTEREST OR WOULD LIKE TO DISCUSS:
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IV. LIFE ISSUES, PERSONAL, AND PROFESSIONAL DEVELOPMENT:

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a. Have you ever been party to a civil lawsuit?*
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b. Have you ever been arrested or convicted of a misdemeanor or felony?*
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TERMS OF ACCEPTANCE of STUDENT AGREEMENT*
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I certify that my answers are correct and complete to the best of my knowledge,
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