APPLICATION FOR FIELD PLACEMENT

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Theory and Practice I and II

NAME____________________________________ E-mail_______________________

Home Address______________________________ Phones _____________________

Present Campus Address________________________ Phone______________

Where will you be living next year?____________ Do you have a working car? _________

Where was your Social Fieldwork Placement?___________________________
List other social service oriented paid or volunteer work. (use the other side of this form if needed)
 
 
 
 
 
 

Describe the client populations or the problem areas with which you would like to work next year. (use the other side of this form if needed)
 
 
 
 
 
 

I have read, and agree to abide by the NASW, Social Work Code of Ethics (see Social Work Student Manual or social work textbooks)

___________________________________ _________
                             (name)                                          (date)

I have read the Theory and Practice I and II Fieldwork Procedures, and the agency list, in the Ramapo College Social Work Web Page

 ___________________________________ __________
                          (sign name)                                        (date)

I give my permission for the Field Education faculty to give information about me to the agency. Please be aware than in increasing number of agencies require fingerprints, criminal background checks or drug testing.

Sign name __________________________________  date _______________________