Field Program Resource Guide Social Work Field Practicum Agencies
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Social Work Field Practicum Agencies

COMMUNITY AGENCY INFORMATION FORM

Please take a few minutes to complete the following form. Your agency information will be included in the Helen Bader School of Social Welfare Field Program database and will also be included in our on-line Agency Resource Book, which is available for our social work students. If you are a large agency with multiple programs, please complete a separate form for each program that accepts social work students. (Our database is organized by individual programs within larger agencies due to the complexities of many of the agencies that we work with.)

If you have any questions regarding this form please contact the Director of Field Education: Jeanne Wagner: jeannew@uwm.edu or 414-229-6501.


* Indicates a required field
  Sep 01 2014
*
 
 
*
 


* (address line 1)
(address line 2)
* * * -
* (select Wisconsin county or "not in Wisconsin")


* (address line 1)
(address line 2)
* * * -
* (select Wisconsin county or "not in Wisconsin")


* (first name) (last name)
*
 
* (area code)
(1234567 - omit dash)


* Yes No

* Yes No

Do you accept BSW or MSW students? *   Yes No   *   Yes No

Graduate students interested in becoming Licensed Clinical Social Workers must complete a minimum of two semesters of supervised clinical field training in a primary clinical setting (a facility, or a unit within a facility, whose primary purpose is to treat persons with a DSM diagnosis) where more than 50% of the practice is to assess and treat interpersonal and intrapsychic issues in direct contact with individuals, families or small groups (requirement of the State of WI Department of Regulation and Licensing).

* Yes No


Social Work Practice Areas
(check all that apply)

Behavioral / Physical Health
Alcohol/Drug/Substance Abuse
Behavioral Health/Community Mental Health
Medical Social Work
Administrative Social Work
Other

Child Welfare
Children and Youth
School Social Work
Administrative Social Work
Other
 
Gerontology
Aging/Gerontological Social Work
Administrative Social Work
Other

Other
Criminal/Restorative Justice
Community Outreach
Developmental Disabilities
Occupational/Industrial Social Work
Physical Rehabilitation Services
Public Assistance Programs
Other



Agency Field Instructors
Please include all agency staff that are able to consider the placement of a social work student.
(At least one instructor is required.)

Instructor 1:
* (first) (last)
* BSW MSW Other (other)
*
* (area code)
(number)
(extension)
  (area code)
(number)
Instructor 2:
(first) (last)
BSW MSW Other (other)
(area code)
(number)
(extension)
(area code)
(number)
Instructor 3:
BSW MSW Other (other)
(area code)
(number)
(extension)
(area code)
(number)
Instructor 4:
BSW MSW Other (other)
(area code)
(number)
(extension)
(area code)
(number)
Instructor 5:
BSW MSW Other (other)
(area code)
(number)
(extension)
(area code)
(number)
Instructor 6:
BSW MSW Other (other)
(area code)
(number)
(extension)
(area code)
(number)