LOYOLA UNIVERSITY CHICAGO

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					        LOYOLA UNIVERSITY CHICAGO - SCHOOL OF SOCIAL WORK

                      FIRST LEVEL FIELDWORK APPLICATION

Please fill out this form to apply for a first- level field work placement.
     The goal for the first year placement is to broaden your knowledge, expose you to new
        opportunities, and give you a well-rounded experience
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     You must complete a total of 480 hours at your 1 level field placement
     Once your application has been reviewed, you will be given one referral for a field site for
        you to contact within two days. If you do not contact them within that time frame you may
        not get a placement for that semester.
     Applications for first-level fall and spring placements are due as soon as you are admitted
        and referrals are made on a first come first serve basis
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     Applications for first-level summer block placements are due by February 1
     Incomplete applications and applications received too close to the start date may or may
        not be considered for a placement
     Pleas note that ALL communications regarding your field placement will be done through
        your Loyola email account

                                 Please submit the following:
                         1. completed application 2. resume

Date:


Name:
           (Last)                         (First)                                   (Middle)

Current Address:
                       (Street)


                        (City)                      (State)                 (Zip)

Anticipated Address or Geographic Area during 1st Year Placement:


(Street)                         (City)                   (State)           (Zip)

Current Home Phone:                                           Cell Phone:


Loyola E-Mail:
All communication will be done through your LUC account


Emergency Contact:                                             Phone:
Anticipated 1st level Fieldwork Time Frame
(Please check first and second choice)
[ ] Fall (Sept-May, Tuesdays/Thursdays, 16 hours per week)    Year [    ]
[ ] Spring (Jan-Aug, Tuesdays/Thursdays, 16 hours per week)   Year [    ]
[ ] Summer Block (May or June- Aug, 30-40 hours/week)         Year [    ]

Academic Enrollment Status for field:
Keep in mind that fall & spring field work is on Tuesday and Thursdays for 16
hours a week regardless of full or part-time status.
      [ ] Full-time
      [ ] Part-time


What courses have you taken and/or are your enrolled in for your MSW?



What languages do you speak fluently?


Do you have a car available for fieldwork?


Are you currently on academic probation?

What is your expectation of a first level placement?




What is your ultimate goal after getting this degree?




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This application form is intended to convey information that will be helpful
in determining fieldwork placements. Although the experiences and
interests of the applicants are taken into consideration, educational needs
take precedence over all other factors involved in the assignment of
students to fieldwork agencies. The information on this application may be
shared with an agency field instructor, field liaison, and/or Director of
Internships.

Applying for a placement is a competitive process. Once applications are
received by the internship coordinators, the placement process begins.
Similar to a job interview, all students must interview for internship
placements. Students are not guaranteed specific placements since the
internship placement process is competitive. Students often compete with
fellow Loyola students as well as students from other schools.

Please note that a background check, including but not limited to criminal
history and fingerprinting, and health screening may be required for
placement in certain settings. Note that these may be at student’s
expense. Please discuss this with your Internship Coordinator if you have
questions or concerns regarding these requirements.


Signed:                                               Date:

If e-mailing the application, please type in your name/date above.




                     Please email or fax completed form to
                     Hilary Gilway in the Fieldwork Office:
                           Lewis Towers Room 850
                              Fax: 312-915-7090
                               hgilway@luc.edu




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posted:9/16/2012
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