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 1
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