2016-17 Field Agencies Department of Social Work (MSW and BSSW)
Thank you for your interest in becoming a field placement agency for our BSSW and/or MSW students during the 2016-17 academic year. We invite you to take 5-10 minutes to fill this form so we can gather information about your agency and the internship opportunities available.

Please scroll all the way down and click the submit button, otherwise your form will not be submitted.

After you complete this form, a member of the Field Office will contact you to arrange an agency visit. We value our partnerships with our community, and look forward to building this relationship.

Captionless Image
Agency Information
Agency Name
Your answer
Program(s) within Agency that Intern will primarily be placed:
If there are distinct programs that accept interns within your agency, please make sure to submit a SEPARATE form for EACH program. (example: if you have a Child/Youth Program and an Adult Program that both accept interns).
Your answer
Special Populations that Agency PRIMARILY serves:
Please only select the client groups below if they represent a significant population you serve. The purpose of this question is to determine which client groups an intern will likely have an opportunity to work with during their field placement.
Agency Website:
Your answer
Agency Address
Street Address:
Your answer
City
Your answer
State
Zip Code
Your answer
Agency Contact Person Information
This is the first point-of-contact who students will contact directly to request an interview for a field placement. If your agency has more than one program with different contacts, then a separate form should be completed for each program with that program's contact information.
Agency Contact Person Name:
Your answer
Agency Contact Person Phone:
Your answer
Agency Contact Person Email:
Your answer
How do you prefer students to contact you to request an interview?
You may select multiple options.
If there is a specific application process or instructions, please detail these below.
Most students contact agencies by submitting a resume and cover letter requesting an internship interview via email. It is up to the agency to determine whether or not to grant the request for an interview. If you prefer an alternate method of initial contact please let us know below.
Your answer
Field Instructor Information
Please visit our website for additional requirements of Field Instructors, including supervision requirements.
Is the agency available to provide a Field Instructor to supervise students?
One Field Instructor may supervise more than one student.
Required
Will the Field Instructor be the same person as the Agency Contact Person listed above?
Will the Field Instructor be located on-site and be available to the student interns during internship hours?
Student Intern Request
How many students are you interested in accepting as interns in the 2016-17 year?
Please select the number of students and the level of students you are interested in ACCEPTING next year. Agencies will have the opportunity to interview all prospective students before deciding to offer them a placement. We typically send more than the number of requested students to interview at each agency so that both the student and the agency can determine if the match is a good fit.
1 student
2 students
3 students
4+ students
BSSW Student(s)
MSW Foundation Year Students
MSW Concentration Year Students - Individual and Families
MSW Concentration Year Students - Macro
Have you worked with a student from the MSU Denver Department of Social Work within the last 2 years? (either in 2013-14 or 2014-15 academic year)
Please only answer this question regarding students you are working with (or have worked with) from MSU Denver's Department of Social Work. We understand many agencies work with students from other MSW programs OR from different undergraduate programs within MSU Denver. The purpose of this question is to determine how recently each agency has worked with our own department.
Required
Practice Opportunities
In addition to filling out the information below, if you have a separate internship description that we may provide to students, please email it as a Word of PDF file to field@msudenver.edu
Which of these DIRECT CLIENT CONTACT opportunities will the student be engaged in during the field placement?
Which of these MACRO PRACTICE opportuntities will the student be engaged in during the field placement?
Additional Information
Is use of a personal vehice a requirement for this internship?
Is a Stipend offered to students accepted into this field placement?
Your answer
Does the student NEED to be able to speak a language other than English at this internship?
Your answer
Does this internship offer night and/or weekend hours?
Your answer
Comments/Other:
If there is any adidtional information that you believe would be helpful for us to know, please comment below.
Your answer
Internship Job Description: Please provide a brief summary of the key responsibilities that an intern will assume in their internship. If you would prefer to submit an Internship Description as a PDF or Word document in lieu of completing this section, please write "see internship description" in the space below, and email the description to field@msudenver.edu.
You may choose to write this as a list, for example:

complete intakes for walk-ins; manage a caseload of 3-5 clients to provide case management; consult and coordinate care with other agencies; provide educational workshops to schools and hospitals; co-facilitate one psycho-educational group a semester; attend community advisory board meetings; manage volunteer program

OR you may choose to provide a brief summary of the internship, for example:

Students will work within a mentoring program to recruit student participants and volunteer mentors. They will assist with intake assessment interviews and with planning the new mentor trainings. They will serve as a liaison with agencies involved in the student's lives, including schools, juvenile justice, and social services. Interns may provide case management services in the first semester, and lead into providing supportive counseling for an individual caseload of 3-5 students in the second semester. Students will also select 2 other projects to focus on during the their internship such as grant writing, helping to provide ongoing training workshops, fundraising, program evaluation, and attending community advisory meetings.

Provide Internship Job Description here:
Your answer
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM!
A member of the Field Office will contact you with additional information about the field placement process. We sincerely appreciate your interest in partnering with the MSU Denver Department of Social Work!

Our internships for the 2016-17 year will begin the week of August 22, 2016 and end the week of May 6, 2017.

Please note: Our students will begin contacting agencies to request interviews on February 15, 2016.

Students from various schools and programs may be contacting you for interviews before our February 15th start date. Our placement process is structured, and we make efforts to carefully place students based on the individual student and our knowledge of each agency. In order to provide your agency and the student the most valuable experience possible, we take time with the matching process and it is helpful to know ahead of time that agencies will reserve their decision making process until MSU Denver students have been able to connect and interview with their matched agencies.

Please keep our timeline in mind when navigating the field placement (internship) process!

THANK YOU!

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms
Google Forms