Anderson University Social Work Program
APPLICATION FOR SOCIAL WORK PRACTICUM FIELD PLACEMENT
This information will be used to help select an agency for your practicum, and will also be shared with your agency field instructor.
Personal Identification:
Name: James G. Snider University Telephone #: 649-8775
University Address: 1706 E. 1st St., Apt. B-1
Permanent Address: 1706 E. 1st St., Apt. B-1 Zip Code 46012-3161
Permanent Telephone: (765) 649-8775
Birthdate: March 3, 1976 Age: 22 Birthplace: Virginia Beach, VA Marital Status: Married
Will you have the use of a car during the practicum? Yes If not, and agency cars are available, do you have a valid driver's license?
Please describe any factors which must be considered in the selection of your field placement or your ability to carry out field assignments: I already am working 40+ hours per week in a social work setting.
Academic Information: Indicate courses completed and planning to complete with month and year.
comp.
Introduction to Sociology
comp.
Introduction to Social Research
comp.
Social Problems
comp.
Introduction to Field Experience
comp.
Intro to Social Welfare and Social Work
comp.
Social Work Practice
comp.
Human Behavior and Social Environment
ptc: 12/98
Social Work Practice With Families and Groups
comp.
Social Welfare Policy
ptc: 5/99
Social Work Practicum
ptc: 12/98
Social Work Practice With Communities and Organizations
comp.
Personal and Community Health
comp.
American National Government
comp.
General Psychology
comp.
Abnormal Psychology
Family Law & Public Policy
comp.
Human Sexuality
Child Welfare
Mental Health
Social Gerontology
Physically Handicapped
comp.
Race & Ethnicity in America
Marriage & Family Therapy
When do you expect to graduate? (month and year) May 1999.
Human Service Experiences
List in chronological order volunteer, employment and internship experiences you have had during your university years.
Dates
Agency & Address
Kind of Work
Paid or Volunteer?
Full or Part-time?
Sept. 1995 - Sept. 1996
Marriott at Anderson University
Student Manager
Paid
Part-time
Sept. 1996 - Nov. 1996
Center for Mental Health
ADLs of mentally ill adults
Volunteer, paid
Part-time
Nov. 1996 - Current
Center for Mental Health
ADLs of mentally ill adults
Paid
Full-time
Sept. 1997 - Nov. 1997
Anderson Center
Social work with adolescents
Volunteer
Part-time
Feb. 1998 - April 1998
Salvation Army
Social work with clients
Volunteer
Part-time
Which of these experiences seemed the most meaningful? Reason?
The Center for Mental Health. It was at the Center that I found my passion in the social work field. I had never thought I would be comfortable working with adults and older adults with major mental illnesses until I had the opportunity to intern at CMH. Once I was in place and began working with these individuals I determined that I wanted to work field of mental illness whether it be in case management or counseling.
List any organization memberships, committee activities and/or leadership experiences you have had during university years.
Member: Alpha Lambda Delta
Member: Phi Eta Sigma
Chair Person: SCORE Committee at the Center for Mental Health
Committee Member: Center for Mental Health Newsletter
Responsibility: Begin on-call for CSS at CMH in October 1998
Certification: To receive QMHP late in 1998
Presenter: Geneva Conference ofr the G.R.I.P. Program
Field and Career Interests:
What are your career interests and plans after graduation?
To work in the field of mental health in a case management role through graduate school. Upon graduation with a MSW, I want to move to Wisconsin, staying in the field of mental health and possibly counsel privately or in an agency such as the Center for Mental Health or Anderson Center.
Field Placement Interests:
List your areas of interest (not specific agencies) with regard to your field placement:
Fields of practice (i.e. child welfare, corrections, mental health, schools, etc.)
1. Adult Mental Health
2. Corrections
3. Child Welfare
Target populations (i.e. abused children, adult offenders, chronically mentally ill, pregnant teens, etc.)
1. Chronically mentally ill
2. Adult offenders
3. Abused children
Additional comments:
As I am already working at the Center for Mental Health, I would like to continue there through my practicum. I have made arrangements with management at CMH to change my shift time from evenings to days and responsibilities from Activities of Daily Living to case management. This would be complete new learning for me.
Signature Date
??
Anderson University Social Work Practicum Application
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