E. Field Instructors for 2008-2009

Fill in all requested information for each field instructor who will be supervising an Adelphi student next year.

*Field Instructors for BSW students must have a minimum of 2 years post MSW experience. Field Instructors for all other levels must have at least 3 years post MSW experience. All first time Field Instructors must attend a free, 12 session Seminar in Field Instruction concurrent with supervising the student.

Instructor #1

Name:
Program Site:
Address 1:		City:
Address 2:		State:	Zip:
Phone:

M.S.W. degree date:
SIFI completed?	Yes No
If yes, where?	name of sifi school
If yes, when?	SIFI completion date
Note the number of students at each level for this instructor
B.S.W. Jr.	B.S.W. Sr.
M.S.W. 1st	M.S.W. 2nd
Total # of students for this field instructor:

Instructor #2

Name:
Program Site:
Address 1:		City:
Address 2:		State:	Zip:
Phone:

M.S.W. degree date:
SIFI completed?	Yes No
If yes, where?	name of SIFI school
If yes, when?	SIFI completion date
Note the number of students at each level for this instructor
B.S.W. Jr.	B.S.W. Sr.
M.S.W. 1st	M.S.W. 2nd
Total # of students for this field instructor:

Instructor #3

Name:
Program Site:
Address 1:		City:
Address 2		State:	Zip:
Phone:

M.S.W. degree date:
SIFI completed?	Yes No
If yes, where?	name of SIFI school
If yes, when?	SIFI completion date
Note the number of students at each level for this instructor
B.S.W. Jr.	B.S.W. Sr.
M.S.W. 1st	M.S.W. 2nd
Total # of students for this field instructor:

Instructor #4

Name:
Program Site:
Address 1:		City:
Address 2:		State:	Zip:
Phone:

M.S.W. degree date:
SIFI completed?	Yes No
If yes, where?	name of SIFI school
If yes, when?	SIFI completion date
Note the number of students at each level for this instructor
B.S.W. Jr.	B.S.W. Sr.
M.S.W. 1st	M.S.W. 2nd
Total # of students for this field instructor:

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F. Brief description of agency (client population, field of practice)

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G. Description of Student Assignment(s)

1. Individual/Family Practice
Describe student's primary individual/family practice assignment:



2. Group Practice
(see pp. 15 of the Field Education Manual for information on developing group assignments)
Describe student's group practice assignment:


3. Community Intervention/Macro Practice
Describe student's macro practice assignment:


4. Research Opportunities
Describe research opportunities in which students may become involved:


5. Agency Meetings*
Please identify meetings (days/times of week) that will be required or recommended for students placed in your agency (e.g., team meetings, case conferences, department meetings, group supervision, grand rounds, staff developments, etc.):

*Please be aware that students may have complicated academic schedules which need to be considered in determining expectations for participating in agency meetings.

 

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H. Other Requirements

1. Does your agency require more than one evening/week? (please detail):


2. Please detail any pre-placement medical clearance requirement for students
placed in your agency :


3. Other requirements or considerations for placing students at your agency:

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I. Transportation and Access to Agency

1. Please describe agency location and access to public transportation:


2. Please describe agency's accessibility for students with disabilities: