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Angelo State University
Department of Social Work

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MSW Field Education Application Form B

In a well-written format, please address each of the following questions:

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Please address the following questions:

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(Please include any physical limitations/challenges you may have which might affect your placement in certain Field Education settings.)
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b. Do you currently have any emotional, mental, or behavioral issues?*
For which you have not sought treatment?
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What influence has this had on you today?
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And how have they affected you?
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(such as family, friends, or other relevant social systems)?
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How do you respond when stressed and what coping mechanisms do you use?
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What your expectations are, and what most concerns you about this Field Education experience:
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Involving your personal values and the social work professional values:
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FIELD EDUCATION REQUIREMENTS AND STUDENT COMMITMENT:

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By checking the boxes below, you are indication you meet the stated requirements.

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1. I verify that all information contained in this application is true and accurate; and that I have fully disclosed relevant information.*
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2. I understand that my application will be reviewed and discussed by the ASU social work faculty to determine my readiness for the Field Education.*
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4. I agree to comply with all the requirements of the field education, prior to and during the actual placement, as stipulated in the Field Education Manual.*
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5. I have read the NASW Social Work Code of Ethics, the Texas State Board of Social Worker Examiners’ Code of Conduct and Standards of Practice, and agree to abide by these Codes at all times.*
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6. I understand that although I have filled out a field education application, interviewed at a field education agency, and passed all my social work courses this does not guarantee that I will be able to be placed at a field agency and/or be able to complete my field education experience.*
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TERMS OF ACCEPTANCE

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TERMS OF ACCEPTANCE OF FIELD EDUCATION REQUIREMENTS AND STUDENT COMMITMENT:*
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TERMS OF ACCEPTANCE OF VIOLATION OF REQUIREMENTS*
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TERMS OF ACCEPTANCE and SIGNATURE*
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I certify that my answers are correct and complete to the best of my knowledge,
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