Practicum Manual

Social Work
Practicum Manual
Bethany College
Lindsborg, KS
TABLE OF CONTENTS
PAGE
Introduction 1
Plan for Practicum 2
Approval of Practicum Placement 2
Criteria for Becoming an Agency Practicum Instructor 3
Responsibilities of the Agency Practicum Instructor 3
Expectations of the Student 5
The Practicum Process 7
Statement of Non-Discrimination 8
Liability Issues 8
Student Evaluation 8
Gatekeeping Role of the Agency Practicum Instructor 9
APPENDICES Location
Practicum Forms and Assignments Related to the student A
Course Objectives B
Agency Application Forms C
Student Practicum Application D
Stipend/Scholarship or Employment Based Practicum E
Post Practicum Evaluation Forms F
College Policies G
Code of Ethics G
BSRB Form G
Bibliography H
Revised – 9/7/2006 1
INTRODUCTION
Social work education has a long tradition and history of being grounded in the practice place.
Having emerged from "apprenticeship" roots to the formal classroom, it is essential that social
work education never divorce itself from the practice field. Agency Practicum Instructors are
key figures in this experience as they act as mentors and teachers for the students. A
cooperative venture between student, agency, and college is necessary in order for a
successful practicum experience to be completed. Bethany College is most grateful to those
dedicated professionals who volunteer their time and energy to act as Agency Practicum
Instructors for our students. This manual sets out the expectations and requirements of the
practicum experience and contains the contractual and evaluation tools to be used throughout
the placement. It is the beginning point upon which the practicum experience is built.
As the most salient experience of the social work education process, the field practicum
integrates the elements from the entire social work curriculum. Objectives and outcomes from
other required courses are assigned to practicum. Many of these are detailed into course
outcomes that are skill focused. These detailed outcomes serve as a guideline to the
knowledge, values, and skills in which the student should achieve competency by the end of the
practicum experience and form the criteria by which the students are evaluated at midterm and
at the end of their practicum experience. They are found in Appendix B of this manual
SW396, Social Work Seminar, taken concurrently with practicum, places emphasis on the
integration and evaluation of theory, experience, and professional and personal values. The
two experiences together aid the student in developing a unique philosophy of social work,
approach to generalist social work, and professional style of practice.
Revised – 2/16/06 1
PLAN FOR THE PRACTICUM
The practicum is structured on a block model with students in the Agency full time, for the
fourteen weeks of the semester. The student is awarded twelve credit hours for successful
completion of the practicum. A three credit hour social work seminar (SW396 Social Work
Seminar) is completed concurrently with the practicum. Students return to campus for a three-
hour seminar session once each week. The student is expected to be in the agency full-time,
except for the afternoon of seminar class. This totals to approximately 35-37 1/2 hours per
week or 500-525 total hours.
APPROVAL OF PRACTICUM PLACEMENT
The setting selection occurs during the academic year prior to the year in which the practicum is
to be completed. Four sets of interests must be considered in the selection of the practicum
setting:
1) the objectives and outcomes of the social work education program,
2) the goals of the practicum agency,
3) the goals of the student,
4) the goals and interests of the practicum instructor.
The agency approval process ideally occurs separately (See appendix C for forms) from the
student selection of a practicum.
The matching process involves the College Practicum Director, the Student and the Placement
Agency Director and/or Practicum Instructor. Students submit an application for practicum to
the College Practicum Director that outlines their goals and specific interests with regard to
placement. The College Practicum Director meets with the student to discuss the goals and to
explore possible agencies. If the agency has previously completed the practicum agency
assessment procedure and has been approved by the faculty, the Practicum Director contacts
the agency to determine if the agency is interested in providing a placement for a student. If the
agency has not completed the assessment procedure the Practicum Director initiates the
agency assessment process. If the agency is interested, interviews are conducted between the
student and the agency personnel.
The interviews have two purposes. First, the assignments and activities that will be undertaken
to meet the Practicum objectives during the placement are identified and discussed. Second,
the student and agency personnel assess the appropriateness of the setting for the student.
Either the student or the agency may decide that the placement is not appropriate. When
agreement is reached with regard to activities and appropriateness, the selection process is
concluded with the signing of the practicum agreement. The contract is completed by the
College Practicum Instructor/Director and signed by the Agency Director, Agency Practicum
Instructor, and the Student. Normally the practicum contract will be completed prior to the end
of the academic year preceding the academic year of the practicum. At the end of the
practicum placement the College Practicum Director reviews and assesses the practicum
placement and determine the future of the agency as a practicum placement.
The Practicum Director will attempt to negotiate a practicum contract with any human service
agencies meeting the assessment criteria, and within a reasonable driving distance
(approximately a 75 mile range) from the college. Students have considerable input into the
Revised – 2/16/06 2
process of the agency selection for the placement. Because the practicum program is designed
to provide an intense and integrated experience for students (through both the practicum and
the seminar) faculty strongly recommend that students select settings in communities close to
the college. The cities of Salina, Concordia, McPherson, Wichita and Hutchinson provide many
practicum opportunities all within comfortable weekly commuting distance of the campus. Other
arrangements will be considered upon request.
At the beginning of the practicum, the student’s educational plan is developed by the Agency
Practicum Instructor and student, with consultation and approval of the College Practicum
Instructor/Director. The educational plan consists of a list of the general areas of assignments
and the specific tasks and responsibilities the student will complete during the practicum in
order to accomplish the student learning outcomes for the practicum. The tasks and
responsibilities are based on with the learning outcomes of the social work program in order to
evaluate the distribution of practicum activities across the range of learning outcomes.
CRITERIA FOR BECOMING AN AGENCY PRACTICUM INSTRUCTOR
Practicum is a process of the student not only learning the tasks and roles within the agency,
but also relating that information to broader professional and theoretical issues and knowledge.
Direct instruction, discussion, and role modeling by the Agency Practicum Instructor are used to
integrate social work skills, knowledge, and ethics the student has learned in classroom work.
The following are criteria for becoming an Agency Practicum Instructor:
1. Persons who are Social Workers and have a current valid Social Work License in the
State of Kansas are eligible to be Practicum/Field Instructors. Both MSW and BSW level
practitioners are eligible to work with bachelor level students.
2. Must have at least one-year (preferably two years) experience with the agency
3. Must possess both the ability and the time necessary to undertake this assignment. The
responsibilities are outlined in the section below. If there are questions concerning the
time or ability to carry out theses responsibilities, a conversation with the College
Practicum Director needs to take place.
RESPONSIBILITIES OF THE AGENCY PRACTICUM INSTRUCTOR
The following duties are required in the process of practicum instruction:
1. Participation in training and orientation sessions for agency practicum

instructors.
2. If a new Field Instructor, attend the seminar of new Field Instructor.
3. Facilitation of access to agency support resources for the practicum student including
workspace, telephone, clerical support, supplies, and appropriate travel expenses.
Revised – 2/16/06 3
4. Provision of orientation of the student to the agency. Involvement of the student in
the agency’s programs. The student must have a clear understanding of the agency
system, both externally and internally, and of their role within it. (See Appendix A)
5. Abide by the NASW Code of Ethics in your relationships with clients, colleagues and
students, and include discussions about the Code of Ethics in the field instruction
meetings with the student.
6. Assignment of an appropriate social work caseload and responsibilities to the

practicum student. These duties and responsibilities are related to the student learning
outcomes for the social work practicum. This is done by actively collaborating with the
student and college Practicum Director in the developing, implementation and ongoing
use of a Learning Contract. These learning assignments provide the basis for
assessment of the student’s growth and ability and must include:
a. Involvement with practice activities related to a range of individual, family, group,

and community systems.
b. A significant level of involvement: from initial engagement through conclusion of

the social work process and appropriate to beginning professional social work
staff in the agency.
c. Case/activity assignments covering a range of diversity of cases. (See learning

agreement in Appendix A).
d. An assignment dealing with policy awareness/implementation.
e. Assistance in completing a research assignment in evaluation of individual

practice (single subject design) or program evaluation.
7. Supervision of work assignments within the agency. In some instances, an agency

may assign part of the student’s work assignments to another staff person. When this is
the case, this person must be a staff member with at least one-year experience in the
agency. He/she must meet with the student on a regular basis and guide the student in
the implementation of the agency policy and practices in the daily work. She/he is the
agency person directly responsible for the student for that part of the work. It is
important that this staff person meet with the Agency Practicum Instructor and College
Practicum Instructor/Director on a regular basis to coordinate the work. The Agency
Practicum Instructor remains responsible for the overall supervision, teaching and
evaluation of the student.
8. Provision of practicum instruction. Practicum Instruction differs from task supervision

in that it relates the work to the broader knowledge, skill, and ethical basis of the
profession. This is the primary teaching role of the Agency Practicum Instructor. As
stated above this role is normally played by the same person doing the work/task
supervision. It is expected that at least one hour per week be devoted to the instruction
each week.
9. Coordinating with the College Practicum Instructor/Director. The college

supplements the agency practicum instruction through site visits and through the Social
Work Senior Seminar, in which the students are concurrently enrolled. In most
Revised – 2/16/06 4
instances the College Practicum Director serves as the College Practicum Instructor and
conducts the site visits and supplementary instruction. However, in some semesters,
numbers of students require that another faculty member be assigned to perform this
task with some students. There will be five visits to the agency during the practicum
semester. Three of these visits are primarily coordination evaluation in nature. During
the first visit, the educational learning objectives and agreement are completed and
reviewed. The third visit occurs to review the mid-term evaluation, and the final visit is to
review the final evaluation. The second and fourth visits are primarily focused on
teaching, with the College Practicum Instructor meeting primarily with the student.
10. Informing the College Practicum Instructor/Director of the student’s progress and
difficulties. It is essential that the College Practicum Instructor be kept abreast of how
the student is doing in the agency. This is particularly important when the student is
having difficulties. The College should be notified immediately when concerns arise
rather than wait until the problem is at a crisis level. This allows implementation of a
plan that gives maximum opportunity for resolution of the issues.
11. Completion of the initial (mid-term) and final student performance assessments.
12. Completion of follow-up evaluation form on the practicum experience.
EXPECTATIONS OF THE STUDENT
1. The student will have successfully completed all other social work major requirements
prior to the beginning of the practicum semester.
2. The student will make application for practicum placement as outlined in Appendix A of
this manual and in the Bethany College Catalog.
3. The student will participate in an interview with the Agency Practicum Instructor and/or
other agency personnel prior to the agreement for placement in a particular agency.
4. The student will be concurrently enrolled in SW396 (Social Work Senior Seminar) and
will complete all assignments for both Seminar and Practicum (SW395).
5. The student will behave and dress in a professional manner acceptable to the agency,
and will abide by all agency rules.
6. The student will abide by the NASW Code of Ethics and the Kansas Licensing Law at all
times during the practicum.
7. The student will attend practicum full time (35-37-1/2 hours/week) for the fourteen weeks
of the semester. If the student has to take off significant amounts of time for health or
personnel reasons the following guidelines should be used:
a. Approval must be obtained from both the Agency Practicum Instructor and the
College Practicum Coordinator.
b. The time should be made up by use of flex-time, during spring break or finals week.
Revised – 2/16/06 5
As with any profession, the student should anticipate the need for a flexible schedule. If
significant amounts of time are worked outside regular hours, the compensatory time
should be worked out with the Agency Practicum Instructor.
8. The student will actively participate in the learning process be seeking out help and
information as need, being prepared for supervisory and practicum instructions sessions,
and participating in mid-term and final evaluation of her/his work.
9. The student will complete a follow-up evaluation of the agency and Agency Practicum
Instructor and of the College Practicum Instructor.
Revised – 2/16/06 6
THE PRACTICUM PROCESS
The sequencing of the practicum is summarized in the following outline. The College Practicum
Director is responsible for the administration of the practicum and serves as the College
Practicum Instructor unless another faculty member is assigned due to student load.
Making the placement

1. Assess agency opportunity/capability. (College Practicum Director)
a. Contact agency with regard to interest.
b. Complete agency assessment materials.
c. Make agency site visit.
2. Consult with student about placement. (College Practicum Director)
3. Selecting Social Work Placements

a. Consult with agencies about placement. (College Practicum Director)
b. Student interview with agency personnel. (Student and Agency Personnel)
Finalize educational plan for placement agency. (Agency Personnel, College Practicum
Instructor, and Student)
Orientation and Beginning of Placement for Practicum Instructor and Student.
1. Pre-practicum training for Practicum Instructor on program objectives and materials.

(Conducted by the College Practicum Instructor and Social Work Program Director.)
2. Orientation of Student in the Agency. (Conducted by Agency Practicum Instructor)
3. Opening site consultation first week of semester. College Practicum Instructor meets
with Agency Practicum Instructor and the Student to review learning objectives
material and Practicum assignment.
Practicum Instruction and Supervision
1. Weekly sessions of practicum instruction with the student. (Agency Practicum

Instructor)
2. Periodic practicum instruction by College Practicum Instructor. (2/semester unless

more are needed.)
3. Facilitation of student research project and case study.
E. Assessment of Student Performance
1. Initial assessment during the fifth week of semester. Student and Agency Practicum
Instructor complete materials and review together. Materials are reviewed during on
site agency consultation with the College Practicum Instructor.
2. Final assessment takes place in the final weeks of practicum.

(Student and Agency Practicum Instructor complete materials and review together.
Materials are reviewed during on site agency consultation with College Practicum
Revised – 2/16/06 7
Instructor.)
3. Post semester evaluations by Student and Agency Practicum Instructor are

completed after final evaluation.
STATEMENT OF NON-DISCRIMINATION
Bethany College is an Equal Opportunity institution with policies on Inclusiveness and Diversity,
Sexual Harassment, and Racial Harassment. Practicum agencies are expected to function with
similar policies and be non-discriminatory and non-harassing with students. The College
policies are found in Appendix F
LIABILITY ISSUES
By agreeing to take a particular student for a Practicum Placement, the agency takes on
responsibility for the student’s work in the agency and with the clients of the agency. The
Behavioral Sciences Regulatory Board (BSRB), has clarified that this includes the normal
liability for a person’s work that a supervisor and agency assumes. The liability for supervision
of a Practicum Student’s work is the same as the liability for supervising a regular agency
employee. The supervisor is liable for the work the student does. It is suggested that you
review these responsibilities in both the state law and regulations and the sections of the NASW
Code of Ethics related to both supervision and education of students.
Another issue of liability is the issue of student safety. It is the responsibility of the Agency to
be cognizant of and to inform the student about the safety issues related to the location of the
agency and the nature of the client work. If self defense or client management training is
routinely given to agency employees, it is highly encouraged that this training also be made
available to the student. Students also need to be aware of safety issues in transporting clients,
home visits, and in going and coming from the office in settings where there are significant risks.
All Bethany Social Work students are provided with Liability Insurance through the College
during their practicum. The agency will be provided with an Insurance Certificate verifying this
coverage. Should the agency have questions about this coverage either the College’s Business
Manager, or the College Practicum Director may be contacted. The agency may request that
the student provide additional insurance if it is felt necessary.
Revised – 2/16/06 8
STUDENT EVALUATION
Evaluation of the student in the practicum experience is a joint effort between the student and
the field instructor. Evaluation should be a frank discussion of the student’s performance in the
field and relate specifically to items indicated on the evaluation form. Differences of viewpoint
and opinion may sometimes occur and the opportunity for input from all parties should be a
continuous process involving the student, Practicum Instructor, and College Practicum
Instructor/Director. The evaluation process is designed to serve the continuing growth process
of the student. Growth needs in both knowledge and skills should be pinpointed and serve as a
basis for ongoing measurement of progress. The student, the Agency Practicum Instructor, and
the College Practicum Instructor/Director should sign the mid-term and final evaluation products.
GATEKEEPING ROLE OF THE AGENCY PRACTICUM INSTRUCTOR
The Agency Practicum Instructor is placed in the position of acting as a “gatekeeper” for the
profession. While this term is often viewed in a negative light, the NASW Cod of Ethics and the
BSRB compels social workers to act to prevent the practice of social work by unqualified
persons. The Bethany College Social Work Program is also committed to allowing only
students who demonstrate the ability to provide quality social work service and who comply with
the Code of Ethics to obtain status as a social worker. In the event that a student has, during
placement, failed to perform social work duties adequately or has acted in a way that is
prohibited by the code of Ethics, the Practicum Instructor must be prepared and willing to deal
with the issue in a frank and open manner. While these occurrences are rare, it is important
that the Practicum Instructor understand that her/his responsibility to the profession is primary
and reflects upon their own licensure. The Agency Practicum Instructor is not expected to act
alone in this process, but to request involvement, at the earliest possible point of difficulty, of the
College Practicum Instructor/Director. Joint addressing of the issue and decision-making about
the student’s status will take place.
The Agency Practicum Instructor is required to provide a reference to the BSRB for the
licensure of any student who applies for licensure in the State of Kansas. (See Appendix F)
Any student who receives satisfactory ratings in the final evaluation should reasonably expect to
be recommended for licensure status.
STUDENT ASSIGNMENTS
See Appendix A
Revised – 2/16/06 9
Appendix A
Practicum
Forms
And
Assignments
Related
To The Student
Revised 2/16/06 0
SOCIAL WORK PRACTICUM STUDENT PLACEMENT AGREEMENT
Bethany College social work student (name) ________________________________________,

the Bethany College Social Work Program, and
(agency)_____________________________________________________________________,
agree to collaborate in the provision of a social work practicum experience in beginning

generalist professional social work practice. The particular learning objectives, tasks and
responsibilities involved in this collaboration are outlined in the Practicum Educational Plan
developed by the student, the Agency Director, the Agency Practicum Instructor, and the
Bethany College Practicum Director. The General Provisions of the agreement are:
1. The Agency agrees to serve as a social work practicum setting and to designate an
Agency Practicum Instructor for the practicum student during
______________________ (semester, year).
2. The duration of the practicum experience is 35-37 hours per week for the 14 week
semester specified above. A usual weekly schedule is outlined by the student, agency
practicum instructor and practicum Director.
3. The Agency agrees to permit the student to observe the official Bethany College
vacation and holiday schedules.
4. All parties agree that the student is not eligible for financial remuneration from either the
agency or the College, for his/her practicum experience. Exceptions to this policy may
be made for special stipend programs, or where there are other justified reasons as
determined by the Social Work Program Director and Practicum Director. These
arrangements require planning and approval by the Social Work Program Director and
Field Director. The appropriate form will be completed indicating such approval.
5. The Agency shall reimburse the student for any expenses incurred in performing their
responsibilities for the Agency including transportation expenses when the student uses
his/her personal vehicle for agency purposes. The Agency agrees to provide the student
with a work place, materials, and clerical support in accordance with usual Agency
procedure.
We, the undersigned have completed and/or read the terms of this contract and are in
agreement with these terms.
____________________________ ________________________________
Agency Director (if needed); Date Bethany College Practicum Director; Date
________________________________ ________________________________
Agency Practicum Instructor; Date Bethany College Student; Date
Revised 2/16/06 1
SUPERVISION SCHEDULE AGREEMENT
Social Work Practicum
Bethany College
Date:______________________________
Name of Student:____________________________________________________
Name of Practicum Instructor:___________________________________________
Practicum Agency/Organization:
_____________________________________________________________________
Name Telephone
_____________________________________________________________________
Address E-Mail
Schedule and Special Conditions
Agency Scheduled Hours:____________________________________________
Agency Practicum Instruction (1 1/2-2 hrs Weekly, Day and Time) _____________
Educational Plan Review Meeting (Day and Time) _______________________________
Initial Assessment (Day and Time) ___________________________________________
Final Assessment (Day and Time) _________________________________________
Special Conditions and Arrangements (School Holidays, Transportation Arrangements, etc.):
Revised 2/16/06 2
Student Learning Objectives
The Student Learning Outcomes for SW395 Social Work Practicum are presented in the Social Work Curriculum Document. (Please
refer to Appendix A. of this manual when developing learning assignments.) In addition the student and Field Instructor are
expected to develop 3-5 outcomes which are student and setting specific. These may focus on particular growth needs for the
student and/or on specific social work roles/tasks of the setting that are not explicitly covered in the general Learning outcomes.
These objectives should be written on the form below. Additional pages may need to be copied.
STUDENT LEARNING OBJECTIVES
Objectives for Learning Activities for Implementation Method of Assessment
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STUDENT LEARNING OBJECTIVES
CONTINUED
Revised 2/16/06 4
EXAMPLE FOR STUDENT LEARNING OBJECTIVES:

1. Display readiness to assume a social 1. Give sufficient work that if student Direct Observation; feedback from field
work staff position. spent too much time in inappropriate instructor, ease with which assignments
2. Develop professional level writing activities it would interfere with ability to are completed on time.
skills. get work done. 2. Write social histories. 1. Agency Practicum Instructor will
3. Case notes. review written work carefully.
2. By end of practicum work will be
acceptable at a beginning worker level.
Revised 2/16/06 5
PRACTICUM STUDENT ASSIGNMENT LIST
Instructions:
The practicum experience is expected to provide learning experiences through assignments that
span the phases of the Social Work Process (engagement, assessment, action, and
concluding/termination), the various sizes of client systems (individual, family, group,
organization, and community), and includes as many diversity experiences as is possible
(race/ethnicity, age, economic/social class, sexual orientation, physical, mental and
emotional disabilities, religion). Use the following format to do the following:
1. List the various assignments (cases, etc) and the anticipated number of each type of
assignment the student will have. For example: the student will have 2 foster care cases,
one adoption case, one residential anger group, etc.
2. Indicate which, if any, of the diversity categories apply to the assignment. Remember
that some categories are relative; For example: in a nursing home, age diversity may be
between a 65 yr old and an 85 yr old. In a foster care agency it might be having toddlers
and teenagers.
3. Indicate which of the phases of the Social Work Process will be the primary focus of
work of the student. For example, will the student primarily be assessing the client or has
the assessment been done and the focus will be on the action phase. It is hoped that each
student will have at least one assignment which they will deal with the client through all
four phases.
4. List some of the primary tasks that the assignment will involve. For example: an
assessment phase assignment might include taking and writing a social history. An action
phase might include working with the client on reintegration of a child into the home.
Revised 2/16/06 6
PRACTICUM ASSIGNMENT SHEET
Systems in The Social Work Process

Practice
Types & number of Diversity category Phase of focus of work Type of tasks involved
assignments
Individual
(When the
primary client
worked with is
an individual
Families
(Includes all
kinds of family
work from re-
integration to
collaborative
work with the
family)
Revised 2/16/06 7
Practice
assignments
Small groups
(this may be an
education group
such as
parenting, or a
support group of
some kind. If
there are no
client groups in
the agency, a
staff group may
be used.)
Organization
(This includes
understanding
the structuring
and functioning
of the agency,
attending
agency
meetings, etc.)
Revised 2/16/06 8
Practice
assignments
Communities:
(This includes
getting to know
the community,
in which the
agency exists,
working across
agency
boundaries with
the client,
professional
meetings, etc.)
Signatures
____________________________ ___________________________________
Agency Director; Date Bethany College Practicum Director; Date
_____________________________ ___________________________________
Agency Practicum Instructor; Date Bethany College Student; Date
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STUDENT ASSIGNMENTS
Practice Research Project: (Assignment for SW396, SW Seminar) During the course of
practicum, students are expected to conduct a research project. This project should be directed
at the evaluation of some aspect of social work practice related to the student’s practicum
assignments. Some examples of such a research project would be:
• Evaluation of case outcomes
• Assessment of the impact of various intervention strategies
• Evaluation of an agency program
• Survey of a client population
While this project is the responsibility of the student, the Agency Practicum Instructor will need to
be involved in helping the student identify a project subject. This should be done early in the
practicum so that ample opportunity is provided for completion of the project.
Case Study Assignment: (Assignment for SW396, SW Seminar) The student will complete an
extensive client case study, including a social history, on one case with which they work. The
case study is to be written in a manner that protects the identity of the client, however, the client
must sign appropriate releases of information, as the case will be presented in the classroom.
The Agency Practicum Instructor’s only responsibility related to this assignment is to insure that
a case is chosen and the releases are signed.
Practicum Journal: Each student will keep a running journal reporting and reflecting upon his
or her experiences in Practicum. Only the College Practicum Instructor/Director reads the
journal. In order for the student to feel free to express their feelings, it is anticipated that the
journal will not normally be shared with the Agency Practicum Instructor. Should issues arise
that need to be shared with the Agency Practicum Instructor, the student will be encouraged to
do so, or the College Practicum Instructor/Director will gain permission from the student to
facilitate a joint discussion of the issue. Should a student choose to share a part of her/his
journal, she/he is free to do so.
Special Journal Entries: 6 special writings are required in the first 7 weeks of practicum. These
are related to activities or assigned discussions to take place in the practicum.
Special Journal Entry Time Management

Due Week #2
F Ask your field instructor to point out a worker to you who is skilled at time management.
Interview this worker about his/her system for task management: how the worker keeps
his/her calendar and daily schedule organized, keeps track of documentation in the field,
organized and uses forms, etc.
F Develop your own system of filing and field “tool kit” with important resources and forms.
F Develop your own material for prioritizing your work.
F Report on both what the interviewed worker told you and what you think will work for you.
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Special Journal Entry Social Work Values, Ethics, and Confidentiality
Due Week #3
F Review your copy of the NASW Code of Ethics.
F Ask your field instructor to review an active case with you, and discuss the potential
ethical issues related to the case, maintaining confidentiality as needed.
F Discuss with your field instructor any potential ethical issues that may arise or have come
up in the past at the agency.
F Explain how each social work value is carried out in the following instances, and cite an
ethical standard that has been/could be involved:
• Working with individuals
• Work with families
• Agency policies and procedures
• Working with other agencies
• Your own practice
F Report a summary of what you learned.
Special Journal Entry Case Planning and Case Management

Due Week #4
F Learn how cases are reviewed in your agency (i.e., formal case consultations, meeting
with a supervisor, etc.) Observe several case reviews. Write about what thoughts,
concerns, and questions came up for you during your observations.
F Talk with your field instructor about your role and responsibilities in building professional
relationships with your clients. Include in the discussion details regarding your
understanding of the appropriate use of authority, providing examples.
F Ask other social workers how they go about closing cases and terminating relationships
with parents and/or children.
Special Journal Entry Worker Safety

Due Week #5
F During a home interview, where there is a potential danger to the social worker, take note
of potential safety concerns and think about what the worker did to minimize/counteract
them. Discuss what you observe with the social worker. If you do not do home
interviews, discuss safety issues within the office.
F Ask your field instructor to explain the procedures for dealing with the threats from
clients.
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F Make a list of safety tips and “what-to-dos” in each of the following areas and review
them with your field instructor:
• Before leaving the office
• Dogs
• Observing the neighborhood surroundings
• Drug labs
• Guns
• Bugs and other “creepy critters”
• Assessing a physical threat
• Anything else you or your field instructor think is important
Special Journal Entry Practice in a Multi-Cultural Environment

Due Week #6
F Seek out a social worker from whom you feel you can learn more about cultural/diversity
competency. Ask if they would be comfortable in discussing with you how personal
values and cultural background could influence perceptions of parenting issues.
F Have a discussion with your field instructor or another social worker about how racial
discrimination and economic oppression can affect a family’s response to the agency
service. Discuss what you can do to address a family’s perception of racism or other
discrimination in the system.
F Ask your field instructor which immigrant populations you will be working with in your
area. What specific cultural considerations do you need to be aware of? Discuss how
new immigrant families can be affected by child welfare intervention. Discuss how you
as a worker can deal with these issues and provide required intervention on behalf of the
client.
Special Journal Entry Stress Management

Due Week #7
F Write down your responses to the following questions:

• What are three things that are personally satisfying to you about working in the
agency?
• What can you do every day to stay in touch with these motivations?
• What helps you relieve stress?
• What can you do to “stick up for yourself” when you feel that there are too many
demands being placed upon you?
• Make a list of three people you can talk to if and when you have a strong
emotional response to a situation at your practicum/work?
• Do you value taking care of your physical and emotional well-being? What about
when there is conflict?
Revised – 2/16/06 12
F Ask other social workers what they do to handle stress.
F Design a personalized plan for how you are going to take care of yourself starting today!
F Report on what you learn.
Revised – 2/16/06 13
ORIENTATION TO THE AGENCY: A CHECKLIST
1. Nitty-gritty items:
_____ dress requirements
_____ Parking
_____ mail and message system
_____ telephone procedures and rules
_____ locations of bathrooms
_____ where to hang coat
_____ lunch times and breaks (is there someone for the student to eat
with the first day?)
_____ agency schedule/holidays
_____ security precautions
_____ policy about reimbursement for travel
_____ establish regular schedule for student
2. Introductions to agency staff:

_____ list of staff names, titles and phone extensions
_____ organizational chart
_____ appointment to meet key staff
_____ description of departments and jobs
_____ give student’s name and number to receptionist
3. The agency:
_____ brief history
_____ agency mission statement and philosophy
_____ eligibility guidelines
_____ funding sources
_____ methods/interventions used
_____ current issues
4. Record keeping:
_____ statistical reports
_____ charts and charting; social histories, etc.
_____ other files
_____ process for getting typing and copying done
5. How should student identify :

_____ oral contacts
_____ reports/correspondence (co-signature?)
Revised – 2/16/06 14
6. Resource materials:
_____ agency library
_____ bibliography or suggested readings
_____ community directory or information on other community agencies
_____ glossary of abbreviations, agency jargon
7. Confidentiality requirements:
_____ release of information
_____ sharing information from client files
8. Orientation to supervision:
_____ schedule/agenda
_____ supervisory notebook or notes
9. The student:
_____ motivations
_____ family background (genogram, ecomap)
_____ autobiography
_____ learning styles, work styles
_____ expectations of placement, supervision
Revised – 2/16/06 15
STUDENT EVALUATION INSTRUCTIONS
Social Work Program
Bethany College
The purpose of this evaluation process is to review the student’s performance and professional
development during the social work practicum.
The student and Field Instructor should fill out the checklist separately and then
compare/discuss them. If an agreement cannot be reached, the Field Instructor’s evaluation
stands. The difference the mid-term and final evaluations is that the mid-term narrative page is
focused on the remedial plan during the remainder of the semester, as opposed to the long
term, future learning focus of the final evaluation.
It is extremely important to be honest and accurate in this evaluation as it is sometimes

requested by either BSRB or graduate schools to clarify discrepancies in applications for
licensure or admission.
You copies of the rating form and appropriate Narrative form should be made for both the
Agency Practicum Instructor and the student. Fill them out completely then meet together to
discuss them. The College Practicum Instructor/Director will make a site visit to the agency to
review the evaluation process and product with the student and Agency Practicum Instructor.
Revised – 2/16/06 16
SOCIAL WORK FIELD PRACTICUM EVALUATION
Student’s Name______________________
Practicum Instructor____________________
Agency__________________________
Initial or Final Evaluation Date___________
For each numbered item below, rate the student’s performance using the
following scale:
4 Always
3 Almost Always (More than half the time)
2 Often (About half the time)
1 Almost Never (Less than half the time)
0 Never
NK No Knowledge (Unable to asses, have not observed/experienced this
behavior)
DU Unable to asses, don’t understand the item
A. The Student will demonstrate an awareness of use of self in the process of

intervention.
_____1. The student’s self presentation is one of professional comportment in

interactions with colleagues.
_____2. The student is able to manage time effectively.
_____3. The student is able to manage paperwork effectively.
_____4. The student is able to use resources to maintain maximum benefit for the
client and agency.
_____5. The student demonstrates appropriate independence in undertaking work

assignments.
_____6. The Student demonstrates awareness of personal values and their impact
on work with the client.
_____7. The student demonstrates accurate self assessment.
Revised – 2/16/06 17
For each numbered item below, rate the students performance using the following scale:
4 Always
0 Never
NK No Knowledge (Unable to asses, have not observed/experienced this behavior)
DU Unable to asses, don’t understand the item.
B.1 The student demonstrates the application of knowledge to enhance the well-
being of people and to work toward the amelioration of environmental conditions
that affect people adversely.
_____1. The student demonstrates ability to choose and apply appropriate

theoretical approaches for the clients needs.
_____2. The student’s work reflects knowledge of, commitment to, and adherence
to the NASW Code of Ethics and major social work principles.
_____3. The student is able to demonstrate use of a “person-in-environment”

perspective with client systems
_____4. The student uses a strengths perspective in working with the client.
B.2 The student demonstrates the application of values and ethics to enhance
the well-being of people and to work toward the amelioration of
environmental conditions that affect people adversely.
_____1. The student is able to restrain from inappropriate imposition of personal

values on clients.
_____2. The student facilitates appropriate focus on ethical issues with the client
system.
_____3. The student considers all ethical dimensions of the situation in the
decision making processes with clients.
_____4. The student performs all evaluative procedures in a manner consistent

with ethical guidelines.
Revised – 2/16/06 18
4 Always
0 Never
B.3 The student demonstrates the application of practice skills to enhance the well-
being of people and to work toward the amelioration of environmental conditions
that affect people adversely.
_____1. The student demonstrates differential use of self in various social work roles and
phases.
_____2. The student’s work with clients reflects ability to establish effective professional
relationships with clients.
_____3. The student is able to effectively engage client systems in a working relationship.
_____4. The student demonstrates the ability to formulate a comprehensive assessment of client
systems.
_____5. The student is able to systematically gather organize and synthesize dated collected.
_____6. The student is able to synthesize data to delineate the parameters of the problem.
_____7. The student demonstrates the ability to formulate a treatment plan and strategies.
_____8. The student demonstrates the ability to contract with client systems for an action plan.
_____9. The student demonstrates the ability to implement the action plan for problem
resolution.
_____10.The student demonstrates appropriate closure with client systems.
C. The student demonstrates competent use of oral and written professional

communications.
_____1. The student demonstrates the ability to express self clearly, both orally and in writing.
_____2. The student demonstrates the ability to use available tools to aid in written
communication such as Dictaphones and computers.
Revised – 2/16/06 19
4 Always
0 Never
_____3. The student is able to focus the content of written work according to the varied purposes
it serves.
_____4. The student uses the appropriate language of the practicum setting and the profession.
D. The student demonstrates use of professional supervision and commitment to life long
learning.
_____1. The student prepares for the supervisory conference.
_____2. The student interacts with the supervisor in a productive manner (not passive).
_____3. The student is able to integrate constructive feedback.
_____4. The student makes use of professional reading and attending training and workshops.
_____5. The student is able to adjust work with the client based on self assessment.
_____6. The student demonstrates the ability to integrate and generalize new knowledge.
E. The student demonstrates the ability to perform critical assessment, implementation,

and evaluation of agency policy and programs, within ethical guidelines.
_____1. The student demonstrates understanding of agency policy/procedures.
_____2. The student is able to assess the impact of policy/procedure on the agency system.
_____3. The student is able to assess the impact of policy on the client systems.
_____4. The student is able to practice within the policy guidelines of the agency and program.
For each numbered item below, rate the students performance using the following
scale:
Revised – 2/16/06 20
4 Always
0 Never
F. The student demonstrates the ability to work with diverse individuals in varying
practice situations and settings.
_____1. The student confirms that social services meet the needs of groups served and are
culturally relevant.
_____2. The student recognizes diversity within and between groups that may influence
assessment, planning, intervention, and research.
_____3. The student defines, design, and implement strategies for effective practice with persons
from diverse backgrounds.
_____4. The student appraises the factors that contribute to and constitute being at risk.
_____5. The student uses knowledge of cultural and other kinds of diversity to accomplish
cross-cultural communication.
G. The student demonstrates the ability to use results of research and evaluation to
evaluate and improve practice.
_____1. The student evaluates program outcomes and practice effectiveness.
_____2. The student uses research knowledge to provide high-quality services, to initiate change,
to improve practice, policy, and social service delivery, and to evaluate one's own
practice.
_____3. The student integrates empirical and practice-based knowledge.
Revised – 2/16/06 21
4 Always
0 Never
H. The student demonstrates the ability to use communication skills in work with clients
and colleagues.
_____1. The student builds relationships with individuals and groups.
_____2. The student uses a variety of approaches to asking questions for obtaining needed
information.
_____3. The student listens for content and affect for responding and providing feedback.
_____4. The student communicates empathy.
_____5. The student establishes and uses structure.
_____6. The student uses communication skills for assessment and evaluation.
Revised – 2/16/06 22
INITIAL (MID-TERM) EVALUATION SUMMARY STATEMENT:
Please make any additional explanatory comments and summarize the student’s strengths and
areas where growth I needed. Specify a plan of action to remedy areas of significant needed
growth (0 or1 ratings).
Signatures:
_______________________________ Date: ___________________

Student
_______________________________ Date: ____________________

Agency Practicum Instructor
_______________________________ Date: ____________________

College Practicum Instructor
Revised – 2/16/06 23
FINAL ASSESSMENT SUMMARY STATEMENT:
Provide a short description of the range and nature of the assignments the student had. What is your overall
assessment of the student's practicum performance? In what areas does the student need the most
improvement? What are the student's greatest assets as a beginning professional social worker? What
recommendations would you make for this student's continuing professional development? (Continue on a
second page if needed.)
Signatures:
_______________________________ Date: _________________________

Student
_______________________________ Date: _________________________

Agency Practicum Instructor
_______________________________ Date: ________________________

College Practicum Instructor
Revised – 2/16/06 24
Appendix B
COURSE
OBJECTIVES
Revised – 2/16/06 0
COURSE OBJECTIVES
Practicum assignments and activities are designed to enable the student to fulfill the following social work
program outcomes. By the completion of the practicum, students should be able to demonstrate these outcomes
and specific practice skills at a BSW graduate level. The practicum course incorporates all the social work
program objectives and learning outcomes and has a detailed list of practice skills that serve as specific
behavioral outcomes to measure the student's abilities
SW395 Social Work Practicum, 12 hours
1A. To know ethical principles as presented in the National Association of Social Workers Code of Ethics.
2A. To be aware of personal values.
3A. To demonstrate and advance the values of the social work profession.
4A. To analyze ethical dilemmas including ethical decision-making processes and the ways in which these
dilemmas affect practice, services and clients.
7B. To confirm that social services meet the needs of groups served and are culturally relevant.
8B. To recognize diversity within and between groups that may influence assessment, planning, intervention, and
research.
9B. To define, design, and implement strategies for effective practice with persons from diverse backgrounds.
10C. To appraise the factors that contribute to and constitute being at risk.
27E. To analyze and apply policy practice skills with economic, political, and organizational systems.
28E. To use policy practice skills to influence, formulate, and advocate for policy consistent with social work values.
30F. To explain social work practice as anchored in the purposes of the social work profession with focuses on the
strengths, capacities, and resources of client systems in relation to their broader environments.
31F. To apply knowledge and skill in work with individuals, families, groups, organizations, and communities.
32F. To use skills for engaging clients in appropriate working relationships.
33F. To use skills for identifying issues, problems, needs, resources, and assets.
34F. To use skills for collecting and assessing information and planning for service delivery.
35F. To use communication skills.
36F. To use supervision and consultation.
37F. To identify, analyze, and implement empirically based interventions designed to achieve client goals.
38F. To apply empirical knowledge and technological advances to proactice.
39F. To evaluate program outcomes and practice effectiveness.
44G. To use research knowledge to provide high-quality services, to initiate change, to improve practice, policy, and
social service delivery, and to evaluate one's own practice.
45H. To describe field practicum education as an integral component of social work education anchored in the mission,
goals, and educational level of the program.
47H. To integrate empirical and practice-based knowledge.

Revised – 2/16/06 1
48H. To exhibit professional competence.
49H. To exhibit achievement of program objectives
56CM. To build relationships with individuals and groups.
57CM. To use a variety of approaches to asking questions for obtaining needed information.
58CM. To listen for content and affect for responding and providing feedback.
59CM. To communicate empathy.
60CM To establish and use structure.
61CM. To use communication skills for assessment and evaluation.
62CM. To use knowledge of cultural and other kinds of diversity to accomplish cross-cultural communication.
Revised – 2/16/06 2
Appendix C
AGENCY
APPLICATION
FORMS
1Revised – 9/7/2006
Criteria for Selection of Practicum Agencies:
1. The agency is located within reasonable driving distance of Bethany College (usually
defined as 75 miles). (Under unique circumstances longer distances may be
accommodated.)
2. The agency is invested furthering professional social work education of the student and in
providing the student with experiences toward that end as demonstrated by a signed
practicum agreement form.
3. The agency has adequate resources to support the practicum student including
• Adequate space and tools available so that the student can do their job, i.e. access
to phone, a desk or place to do their work, access to computer or other means of
completing paper work
• Access to supplies and materials needed
• Access to an agency vehicle or mileage reimbursement if travel is necessary.
• Adequate time to orient the student to the agency
• Commitment to the profession and socialization of new professionals shown by
establishing an atmosphere conducive to learning
• Releasing the Agency Field Instructor (who has been or is eligible to be approved
according to stated criteria) from job duties for attendance at training sessions.
• Support for the time the Agency Field Instructor needs to provide field instruction
(both supervision and teaching for the student).
• Ability to provide client assignments and experiences that span the various sizes
of client systems, the full social work phase process, and a range of diversity.
• Willingness to keep the school informed and collaborate with the college
practicum instructor and to complete evaluations of the student.
• Abide by the NASW Code of Ethics
2Revised – 9/7/2006
APPLICATION TO SERVE AS A Bethany COLLEGE PRACTICUM AGENCY
1. AGENCY
___________________________________________________________________
Agency Name
___________________________________________________________________
Contact Person
___________________________________________________________________
Street Address
_______________________________________________(____)______________
City and Zip Telephone
___________________________________________________________________
E-Mail
2. AGENCY MISSION AND OBJECTIVES
3. WHAT ARE YOUR REASONS FOR INTEREST IN HAVING A PRACTICUM STUDENT?
3Revised – 9/7/2006
4. IDENTIFY AGENCY PERSONNEL FOR THE ROLES IDENTIFIED BELOW
A. Agency Director's Name:______________________________
Will this person be the Practicum Instructor? Yes_____ No______
If not, has permission been given to have a social work student?

Yes_____ No______
(Agency Director should sign on last page to indicate permission.)
B. Practicum Instructor's Name:___________________________

Title:____________________________________________(See last page for
contract page.)
(If available attach a current resume. If not give a brief outline of experience.)
C. Will the student be assigned to other workers for part of the practicum work?
If so, explain what the process involved and how the work will be coordinated by
the Field Instructor:
5. Briefly describe the orientation to the agency that the student will receive.
4Revised – 9/7/2006
6. Describe the type of experiences the student will be assigned during practicum.
a. Will the agency be able to provide assignments with all sizes of systems?
(Individuals, Families, Groups, Community).
Please explain any limitations:
b. Will the agency be able to provide assignments that go through the full range of
social work process phases? (Engagement, Assessment, Intervention, and
Concluding/Evaluation).
Please explain any limitations:
c. What range of diversity (race, age, class, gender, sexual orientation, religion,
national origin, mental and physical abilities, etc.) will the student be exposed to?
7. IS SUPPORT AVAILABLE FOR THE SOCIAL WORK PRACTICUM STUDENT?

(This includes work space, telephone, clerical support, supplies, and appropriate travel
expenses.)
5Revised – 9/7/2006
8. DO YOU HAVE ANY SPECIAL REQUIREMENTS OR QUALIFICATIONS OF THE
STUDENT?
9. LIST ANY CLEARANCES, LEGAL REQUIREMENTS, INSURANCE REQUIREMETNS

ECT THAT WILL BE DONE ON THE STUDENT. INDICATE WHETHER THEY WILL BE
DONE BY THE AGENCY, NEED TO BE DONE BY THE SCHOOL, OR NEED TO BE
DONE BY THE STUDENT.
REQUIREMENT/CLEARANCE WHO WILL DO TIMING:

PRE PRACTICUM
OR AFTER START
I hear by agree to accept Bethany Social Work Students for practicum placement in our agency,
subject to appropriate screening and coordination.
_________________________________________________________________
Agency Director Date
__________________________________________________________________
Agency Contact Person (Normally the Practicum Instructor) Date
_________________________________________________________________
Social Work Practicum Director Date
6Revised – 9/7/2006
AGENCY PRACTICUM INSTRUCTOR AGREEMENT FORM
The Agency Practicum Instructor is the student’s primary educational resource within the
agency, and as such agrees to support the educational goals of the field education program.
The field instructor must be willing to assume the overall responsibility for the student’s
educational experiences in the agency. The time commitment required of a field instructor is
approximately 2 hours/week. To qualify, the field instructor must have a BSW or MSW degree
from an accredited social work program and at least two years of successful post-BSW
experience. Specific responsibilities include:
1. Participate in college-sponsored field instructor training and meetings.
2. Prepare for and conduct regularly scheduled weekly conferences with the student.
Conferences are one to one and one-half hours weekly for the semester. A minimum 14
hours of field instruction conferences is expected.
3. Abide by the NASW Code of Ethics in your relationships with clients, colleagues and
students and include discussions about the Code of Ethics in the weekly field instruction
conferences with the student.
4. Actively collaborate with the student and Practicum Director in the developing,
implementation and ongoing use of a Learning Contract.
5. Coordinate any student learning experiences delegated to other staff members.
6. Provide a quality, beginning level, generalist social work education experience for the
student.
7. Provide the student with ongoing feedback on the student’s performance, including
evaluation of both process and content oriented records that are required by the college.
8. Support the student in gaining access to other learning opportunities and resources in
the agency and professional community.
7Revised – 9/7/2006
9. To keep the college informed of the student’s ongoing progress and notify the Practicum
Instructor of any problems.
10. To meet with the college practicum director, or other college practicum faculty, on a
periodic basis. (Approximately 5 times a semester)
11. To do midterm and final evaluations of the student.
12. Complete post practicum evaluation form.
8Revised – 9/7/2006
PLEASE ATTACH A COPY OF YOUR RESUME AND LICENSE TO THIS FORM.
Your signature on this form indicates that you agree to the above responsibilities and that
you have read and endorse the completed Employment Based Practicum Application that
the student is submitting to Bethany College.
Signature ________________________________
Title____________________________
_______________________________ _______________
Social Work License Type, Number Expiration date
Agency______________________________________
Address _____________________________________
_____________________________________
Phone _______________________________________
E-Mail _______________________________________
9Revised – 9/7/2006
Appendix D
STUDENT
PRACTICUM
APPLICATION
Revised – 2/16/06 0
STUDENT SOCIAL WORK PRACTICUM APPLICATION
The senior year Social Work Practicum is in many ways the most important experience of your
social work education. It is the integration of your classroom experiences and personal
development and learning of the past few years. It is also the final assessment of your
readiness to do professional social work. Therefore it is incumbent on the faculty, in conjunction
with you, to carefully assess your readiness to take this next step in the educational process.
This format facilitates that assessment and also serves to facilitate a match between you and a
practicum agency.
Please review the overview information about social work practicum process. You will then need
to complete the steps in the application process and return all the material to the Practicum
Director in order to begin the process of practicum site selection. A review of your readiness to
enter practicum will take place. This usually will be through the review of the material you
submit, but in some cases may involve a face to face meeting between you, the Practicum
Director and the Program Director.
Subsequent to the completion of that review, there will be a meeting between you and the
Practicum Director to talk about the placements you are interested in. Reasonable efforts will be
made to match your wishes with available sites, however, due to changes in agencies, student
numbers or other factors, your first choice may not be possible.
Submit application material to Margaret Presley by; _______________________
Revised – 2/16/06 1
STUDENT PRACTICUM APPLICATION DIRECTIONS
1. HEADING:
Name: ________________________________ Date: __________________
Phone Number: _________________________________________________
Campus Address: _______________________________________________
Semester of Practicum: ___________________________________________
2. If you were given any conditions when you were admitted to the program or since
admission, if so please address how you have resolved these conditions.
3. Have you been or are you in counseling or therapy? If so, explain when and whether you
benefited.
4. Have you ever been convicted of a felony? ____yes _____no

If yes, explain.
Revised – 2/16/06 2
An essay format should be used in answering the following questions. All applications should be
typed.
5. BIOGRAPHIC STATEMENT: The purpose of this statement is to focus on the growth you
have experienced in the social work program.
A. Make a very brief statement about your initial motivations and/or life experiences
that brought you to social work as a major and career. If part of your motivation
has been difficult life experiences, what have you done to resolve those to the
point that they will not interfere with our work with people?
B. Discuss your current view of Social Work as a profession.
C. Discuss the growth you have made thus far in your education and related
experiences:
D. Assess your readiness for practicum based on knowledge, skills, values and
professional comportment. Include a statement of what you feel your strengths
and areas that still need to be focused on are.
6. What specific learning goals do you have for your practicum experience? These should
include not only learning about a specific client population and agency, but also any
personal issues related to your developing professionalism. (ie: more comfort in talking
with people or improve writing skills)
7. What do you feel are important ingredients or characteristics for an agency and field
instructor to have to be a productive learning environment for you? Are their certain
styles on supervision/interaction that are particularly difficult or helpful for you?
8. Are there any particular concerns or limitations that should be considered in placing you
in a practicum? (These might include where you live, physical or other limitations,
transportation difficulties, etc.)
9. If you are representing an Employment Based Practicum please see the Practicum
Director for appropriate procedures and forms.
IT IS EXPECTED THAT THIS ENTIRE APPLICATION (not including the following form)
WILL BE 4-5 PAGES IN LENGTH.
Revised – 2/16/06 3
CRITERIA FOR ADMISSION TO FIELD PRACTICUM PLACEMENT
1. Completion of all the professional level social work courses, except for SW395
(Practicum) and SW396 (Senior Seminar).
2. Successful resolution of any “conditions” given at the time of admission into the program.
3. Continued satisfactory progress in the Social Work Program as defined under
“Continuation in/Termination from the Social Work Program.”
4. The student made application to enter practicum (directions provided), had an interview
with the Director of Practicum, and has the capability to be successful in practicum
including:
• Ability to apply the knowledge, skills and ethics of the profession.
• Emotional maturity and stability to do beginning level social work in an
appropriately supervised setting.
• Professional comportment appropriate for social work.
AGENCY/POPULATION REQUEST
After you have completed the other information requested in the practicum application, use this
form to list your first three choices for the type practicum placement agencies/populations. It is
not necessary to have agencies already in mind. Your population preferences are a starting
point not a final selection. Final agency decisions will be made based on a number of factors
including availability of placement, fit between Field Instructor and student, demand for
placement (if more than one student requests the same agency, the date of submission of
request will be considered) and others.
First population choice_______________________________________________________
Second population choice_____________________________________________________
Third population choice______________________________________________________
Revised – 2/16/06 4
Appendix E
STIPEND/SCHOLARSHIP
OR
EMPLOYMENT
BASED
PRACTICUMS
PRACTICUMS OFFFERING STIPENDS OR SCHOLARSHIPS FOR STUDENTS
Introduction
Occasionally an agency will offer a scholarship or stipend to a student doing a practicum

there. The availability, amounts, and conditions for these vary greatly. A student should
never apply for a particular placement based on it providing funds, nor will the placement
approval by the College Practicum Director be guaranteed or based solely on the money
available. Often students will not even know there is a possibility of financial help until
she/he has been accepted into a practicum. Some agencies have money available to some
students but it is a competitive process to be approved for the money.
If a student is offered a scholarship or stipend for a practicum, the student needs to realize
that the agency has a vested interest in the placement beyond educating a new
professional. Therefore, guidelines have been developed to protect the student’s interest
and the integrity of the practicum education. Basic guidelines and conditions follow.
Purpose: The purpose of offering a stipend or scholarship to a student a stipend or

scholarship for practicum is understood to be 1) to ease the difficulty that not being able
to work during a block practicum presents to the student; 2) toencourage (some times
require) the student to work in the particular agency and/or field of work upon
graduation.
Conditions:
1. The agency is supportive of the student’s educational objectives and provides
support for the student in this role.
2. The learning role of the student must be protected. The student is not an
employee of the agency and cannot be given a full case load or full expectations
of an employee.
3. The Agency Practicum Instructor must provide practicum teaching to the student,
not simply act as an agency supervisor.
4. If the student has previously been an employee of the agency, the student
assignments must be new learning and different from their previous employee
role. (In most cases this person would be considered for an “employment based
practicum” and should follow those guidelines below.)
5. The requirements of accepting the stipend or scholarship need to be clearly set out
in the application/contract that follows.
Putting together the Application for a Stipend/Scholarship Enhanced Practicum:

1. The student submits the regular practicum application materials required for all
students.
2. The agency completes the “Agency Form for Stipend/Scholarship Enhanced
Practicums.”
3. The student fills out the Student Application for a Stipend/scholarship Enhanced
Practicum.
Revised – 2/16/06 1
4. Both forms are submitted to the College Practicum Director and concerns of any
of the parties are addressed.
5. Upon approval by all parties involved, the agreements are signed, and the
practicum is approved.
Note: These additional material must already be on file for the agency or be submitted in
this process:
1. The Agency assessment form
2. The Agency Practicum Instructor Agreement form
3. Agency Practicum Instructor’s Resume
4. A copy of the Agency Practicum Instructor’s Social Work License
Revised – 2/16/06 2
EMPLOYMENT BASED PRACTICUMS
Introduction
The purpose of an Employment Based Practicum (EBP) is to allow the student to use their place of
on-going employment at the site for the field practicum, or to be hired by an agency wishing to pay
them during their practicum. Students may apply for an EBP if the following criteria are met:
1. The student is continuing to work in a social service agency but is placed in anew position
that is a social work position that is clearly distinguished from a para-professional position
previously held. If the student also continues to work additional hours in the previous
position, these hours are clearly distinguished from the practicum hours.
OR
2. The student is hired by an agency (in which they have not previously been employed) with
the agreement that their job is a practicum position. Note: These arrangements are normally
discouraged, because it is difficult for the agency and student to keep the position in a student
learning perspective and not expect the student to take on full employee responsibilities.
3. The educational assignments must be specified and are clearly distinguished from the
student’s employment responsibilities or all the work responsibilities are social work tasks
new to the student.
4. The agency is supportive of the student’s educational objectives and provides support for the
student in this role.
5. A qualified Agency Practicum Instructor is available to supervise the student. It is preferred

that this field instructor not be the student’s employment supervisor if the student is still
working in another position.
An Employment Based Practicum is not:
• An avenue for a student to get educational credit for the work they have been doing on an on-
going basis. An on-going role is not new learning and presumable is a para-professional job.
• A convenient way for employers to get more hours of work out of an employee they value
through adding the practicum on to a full time job. Practicums, as a learning opportunity,
actually provide less work production.
• A “special” practicum. While the setting for an EBP may be different than a traditional
practicum, all of the expectations for field practicum specified by Bethany College are still
requirements of Employment Based Practicum.
Before completing the application the student needs to carefully discuss with his/her employment
supervisor and agency administrator if the above criteria can be met within the student’s place of
employment. Bethany College is committed to working with students to ensure that the field
practicum component of the student’s education is a sound learning opportunity.
Revised – 2/16/06 3
STUDENT APPLICATION FOR EMPLOYMENT BASED APPLICATION
Name: ___________________________________________________
Address: __________________________________________________
Phone: ____________________________________________________
Agency in which you wish to do an employment based

practicum:____________________________________
Agency Address:_____________________________________________
This is (check one) ______________ A place on on-going employment
______________ A new employment opportunity
Explain in detail why it is necessary to have this arrangement of an employment based practicum:
If you have previously been employed in this agency, explain how your new job duties will be
different from your old ones:
If this employment based practicum is not approved, how will it affect your ability to complete
practicum?
Signed: ____________________________________ Date: _______________________
Revised – 2/16/06 4
AGENCY FORM FOR EMPLOYMENT BASED PRACTICUM
Agency: ______________________________________________________________________
______________________________________________________________________________
Address (Street) (City) (State) (Zip)
Telephone ( ) _________________ FAX: __________________ E-Mail _________________
Authorizing Administrator and Title: _______________________________________________
Practicum Student Name: ________________________________________________________
Beginning date of employment in the agency: ________________________________________
Student’s pre-practicum agency position and title: ______________________________________
Length of time in this position: ____________________________________________________
Other prior positions in agency, if any: ______________________________________________
If the student will be placed in an entirely new position (for the student) in the agency, that
position will be: _________________________________________________________
A. Describe the manner in which the agency will provide a qualified field instructor. It is preferable
that this person not be the students work supervisor.
Agency Work Supervisor and Title: _________________________________________________
Proposed Agency Practicum Instructor: ______________________________________________
B. Describe how the Agency will provide and support for the Practicum Instructor to carry out these
responsibilities, including granting the instructor sufficient time and resources to carry out
instructional responsibilities with the student, the agency and Bethany College. Average time is
approximately 2 hours/week.
C. Describe how the field instruction role will be kept separate from the work supervision role, if
both responsibilities are provided by the same person.
Revised – 2/16/06 5
D. Describe the manner in which the agency will provide the range and depth of learning
experiences appropriate to a beginning level social worker.
E. Specify how many hours each week the agency expects the applicant to work to complete both
work and practicum responsibilities. Students are expected to have 35-37 ½ hours/week in
practicum related activities, including field instruction. While there may be some overlap
between work and practicum activities, the agency needs to clearly specify if the applicant will be
expected to “make up” those hours which do not overlap.
Proposed hours in the Agency per weed after beginning Field Practicum:
(a) ______ Number of hours/week in previous (pre-practicum) job after beginning practicum
(b) ______ Number of hours/week designated for practicum activities (separate from previous
job) must be at least 35
(a+b) ______ Total number of hours/week in Agency
___________ Check here if this is a totally new position for the student and all the hours will be
dedicated to practicum
Signed: _______________________________ Date: __________________

(Agency Director)
Signed: ________________________________
(Agency Work Supervisor)
Signed: ________________________________
(Agency Practicum Instructor)
Revised – 2/16/06 6
Putting the EBP Application Together
I. Student Application for Practicum

Submit the regular practicum application materials required for all students
II. Student EBP request form
III. Agency Authorization and Support Form
IV. Additional Material to be on file

If the agency and/or the Agency Practicum Instructor have not previously worked with
Bethany Practicum Students, the following materials need to be submitted in addition to
the letter of support. This material allows us to fulfill CSWE accreditation requirements.
a. Agency Assessment Form
b. Agency Practicum Instructor Agreement form
c. Field Instructors Resume
d. Copy of Field Instructors Social Work License
Revised – 2/16/06 7
Appendix E
STIPEND/SCHOLARSHIP
OR
EMPLOYMENT
BASED
PRACTICUMS
PRACTICUMS OFFFERING STIPENDS OR SCHOLARSHIPS FOR STUDENTS

Introduction
Occasionally an agency will offer a scholarship or stipend to a student doing a practicum

there. The availability, amounts, and conditions for these vary greatly. A student should
never apply for a particular placement based on it providing funds, nor will the placement
approval by the College Practicum Director be guaranteed or based solely on the money
available. Often students will not even know there is a possibility of financial help until
she/he has been accepted into a practicum. Some agencies have money available to some
students but it is a competitive process to be approved for the money.
If a student is offered a scholarship or stipend for a practicum, the student needs to realize
that the agency has a vested interest in the placement beyond educating a new
professional. Therefore, guidelines have been developed to protect the student’s interest
and the integrity of the practicum education. Basic guidelines and conditions follow.
Purpose: The purpose of offering a stipend or scholarship to a student a stipend or

scholarship for practicum is understood to be 1) to ease the difficulty that not being able
to work during a block practicum presents to the student; 2) toencourage (some times
require) the student to work in the particular agency and/or field of work upon
graduation.
Conditions:
1. The agency is supportive of the student’s educational objectives and provides
support for the student in this role.
2. The learning role of the student must be protected. The student is not an
employee of the agency and cannot be given a full case load or full expectations
of an employee.
3. The Agency Practicum Instructor must provide practicum teaching to the student,
not simply act as an agency supervisor.
4. If the student has previously been an employee of the agency, the student
assignments must be new learning and different from their previous employee
role. (In most cases this person would be considered for an “employment based
practicum” and should follow those guidelines below.)
5. The requirements of accepting the stipend or scholarship need to be clearly set out
in the application/contract that follows.
Putting together the Application for a Stipend/Scholarship Enhanced Practicum:

1. The student submits the regular practicum application materials required for all
students.
2. The agency completes the “Agency Form for Stipend/Scholarship Enhanced
Practicums.”
3. The student fills out the Student Application for a Stipend/scholarship Enhanced
Practicum.
4. Both forms are submitted to the College Practicum Director and concerns of any
of the parties are addressed.
5. Upon approval by all parties involved, the agreements are signed, and the
practicum is approved.
Revised – 9/7/2006 1
Note: These additional material must already be on file for the agency or be submitted in
this process:
1. The Agency assessment form
2. The Agency Practicum Instructor Agreement form
3. Agency Practicum Instructor’s Resume
4. A copy of the Agency Practicum Instructor’s Social Work License
Revised – 9/7/2006 2
STUDENT APPLICATION FOR STIPEND/SCHOLARSHIP ENHANCED
PRACTICUM
Name: ___________________________________________________
Address: __________________________________________________
Phone: ____________________________________________________
Agency in which you wish to have your practicum: ____________________________________
Agency Address:_____________________________________________
This agency is offering is (check one)
⁭ One payment at beginning of practicum

⁭ One payment at end of practicum
⁭ Monthly
⁭ Other - Explain
Explain in detail why it is necessary or desirable to have this arrangement for placement.
If you have previously been employed in this agency, explain how your student duties will be
If this stipended/scholarship based practicum is not approved, how will it affect your ability to
complete practicum?
Signed: ____________________________________ Date: _______________________

(student)
Revised – 9/7/2006 3
AGENCY FORM FOR STIPEND OR SCHOLARSHIP BASED PRACTICUM
Agency: ______________________________________________________________________
______________________________________________________________________________
Telephone ( ) ______________ FAX: _______________ E-Mail _______________________
Beginning date of practicum: _____________________________________________________
Ending date of practicum: ________________________________________________________
Amount of stipend/scholarship: ____________________________________________________

⁭ One payment at beginning of practicum
⁭ One payment at end of practicum
⁭ Monthly
⁭ Other - Explain
A. Describe the nature of the scholarship or stipend.
B. Describe any requirement or obligation the student has as a result of receiving the stipend (i.e.
payback time, agreement to work, ect.).
C. Describe how the student’s role will be protected from becoming an employee role (i.e.
learning time).
D. Are there any expectations of Bethany College related to this stipend/scholarship?
Revised – 9/7/2006 4
Signed: _______________________________ Date: __________________
(Agency Director or Person Responsible for Stipend)
Signed: ________________________________ Date: __________________

Signed: ________________________________ Date: __________________

(Student)
Signed: ________________________________ Date: __________________

(College Practicum Director)
Revised – 9/7/2006 5
EMPLOYMENT BASED PRACTICUMS
Introduction
The purpose of an Employment Based Practicum (EBP) is to allow the student to use their place of
on-going employment at the site for the field practicum, or to be hired by an agency wishing to pay
them during their practicum. Students may apply for an EBP if the following criteria are met:
1. The student is continuing to work in a social service agency but is placed in anew position
that is a social work position that is clearly distinguished from a para-professional position
previously held. If the student also continues to work additional hours in the previous
position, these hours are clearly distinguished from the practicum hours.
OR
2. The student is hired by an agency (in which they have not previously been employed)
with the agreement that their job is a practicum position. Note: These arrangements
are normally discouraged, because it is difficult for the agency and student to keep the
position in a student learning perspective and not expect the student to take on full
employee responsibilities.
3. The educational assignments must be specified and are clearly distinguished from the
student’s employment responsibilities or all the work responsibilities are social work tasks
new to the student.
4. The agency is supportive of the student’s educational objectives and provides support for the
student in this role.
5. A qualified Agency Practicum Instructor is available to supervise the student. It is preferred

that this field instructor not be the student’s employment supervisor if the student is still
working in another position.
An Employment Based Practicum is not:
• An avenue for a student to get educational credit for the work they have been doing on an on-
going basis. An on-going role is not new learning and presumable is a para-professional job.
• A convenient way for employers to get more hours of work out of an employee they value
through adding the practicum on to a full time job. Practicums, as a learning opportunity,
actually provide less work production.
• A “special” practicum. While the setting for an EBP may be different than a traditional
practicum, all of the expectations for field practicum specified by Bethany College are still
requirements of Employment Based Practicum.
Before completing the application the student needs to carefully discuss with the college practicum
director and with his/her employment supervisor and agency administrator if the above criteria can be
met within the student’s place of employment. Bethany College is committed to working with
students to ensure that the field practicum component of the student’s education is a sound learning
opportunity.
Revised – 9/7/2006 6
Putting the EBP Application Together
I. Student Application for Practicum

Student submits the regular practicum application materials required for all
students.
II. The Student Submits the EBP request form
III. The Agency Submits Authorization and Support Form
IV. Additional Material to be on file

If the agency and/or the Agency Practicum Instructor have not previously worked
with Bethany Practicum Students, the following materials need to be submitted in
addition to the letter of support. This material allows us to fulfill CSWE
accreditation requirements.
a. Agency Assessment Form
b. Agency Practicum Instructor Agreement form
c. Field Instructors Resume
d. Copy of Field Instructors Social Work License
V. All materials received by College Practicum Director and concerns are addressed.
VI. All parties sign the form and practicum is approved.
Revised – 9/7/2006 7
STUDENT APPLICATION FOR EMPLOYMENT BASED PRACTICUM
Name: ___________________________________________________
Address: __________________________________________________
Phone: ____________________________________________________
Agency in which you wish to do an employment based

practicum:____________________________________
Agency Address:_____________________________________________
This is (check one) ______________ A place on on-going employment
______________ A new employment opportunity
Explain in detail why it is necessary or desirable to have this arrangement of an employment

based practicum:
If you have previously been employed in this agency, explain how your new job duties will be
If this employment based practicum is not approved, how will it affect your ability to complete
practicum?
Signed: ____________________________________ Date: _______________________

(Student)
Revised – 9/7/2006 8
AGENCY FORM FOR EMPLOYMENT BASED PRACTICUM
Agency: ______________________________________________________________________
______________________________________________________________________________
Telephone ( ) _______________FAX: _________________ E-Mail ____________________
Beginning date of employment in the agency: ________________________________________
Student’s pre-practicum agency position and title: ______________________________________
Length of time in this position: ____________________________________________________
Other prior positions in agency, if any: ______________________________________________
If the student will be placed in an entirely new position (for the student) in the agency, that
position will be: _________________________________________________________
A. Describe the manner in which the agency will provide a qualified field instructor. It is
preferable that this person not be the students work supervisor.
Agency Work Supervisor and Title: _________________________________________________
Proposed Agency Practicum Instructor: ______________________________________________
B. Describe how the Agency will provide and support for the Practicum Instructor to carry out
these responsibilities, including granting the instructor sufficient time and resources to carry out
instructional responsibilities with the student, the agency and Bethany College. Average time is
approximately 2 hours/week.
C. Describe how the field instruction role will be kept separate from the work supervision role, if
both responsibilities are provided by the same person.
Revised – 9/7/2006 9
D. Describe the manner in which the agency will provide the range and depth of learning
experiences appropriate to a beginning level social worker.
E. Specify how many hours each week the agency expects the applicant to work to complete
both work and practicum responsibilities. Students are expected to have 35-37 ½ hours/week
in practicum related activities, including field instruction. While there may be some overlap
between work and practicum activities, the agency needs to clearly specify if the applicant
will be expected to “make up” those hours which do not overlap.
Proposed hours in the Agency per week after beginning Field Practicum:
(a) ______ Number of hours/week in previous (pre-practicum) job after beginning practicum
(b) ______ Number of hours/week designated for practicum activities (separate from previous
job) must be at least 35
(a+b) ______ Total number of hours/week in Agency
___________ Check here if this is a totally new position for the student and all the hours will be
dedicated to practicum
Signed: _______________________________ Date: __________________

(Agency Director)
Signed: ________________________________ Date: __________________

Signed: ________________________________ Date ___________________

(Agency Practicum Instructor)
Approved: _____________________________ Date: ___________________

(College Practicum Director)
Signed: _______________________________ Date: ___________________

(Student)
Revised – 9/7/2006 10
Appendix F
POST PRACTICUM
EVALUATION FORMS
EVALUATION OF THE PRACTICUM EXPERIENCE
By Agency Practicum Instructor
Bethany College Social Work Program
This form is one component of on-going evaluation of the Bethany College Social Work Program.
The feedback will be utilized in Assessment of the Practicum process. Please be honest and
complete in your responses.
Semester: ___________
Name_____________________
Agency____________________ E-Mail: ____________
A. How many years have you been a Field Instructor? _________________
B. Have you attended the basic Field Instructor Training? _______________
Advanced? ______________
Rate the following Practicum Activities by circling 1-5 (5 being high)
1. Site visit before beginning of placement to assist 1 2 3 4 5

with placement planning and completion of contract.
(may have taken place prior to the current year)
2. The process of the student interview and placement 1 2 3 4 5

selection process
3. Adequate clarification/orientation to the social work program in the pre-practicum

training/meeting
a. curriculum 1 2 3 4 5
b. expectations for student’s performance 1 2 3 4 5
c. field instruction policies, forms and procedures 1 2 3 4 5
d. educational objectives of field instruction 1 2 3 4 5
4. Provision of resources, training and/or suggestions

for improving your field instruction skills 1 2 3 4 5
5. The process of engaging the student in the practicum

process at the agency (development of the educational 1 2 3 4 5
contract, case assignments, orientation etc.) facilitated
the student practicum experience
Revised – 2/16/06 2
6. Please rate your experiences in communicating with
the College Practicum Director or other College Practicum Instructors
1 2 3 4 5
(not enough) (about right) (too much)
a. Demonstration of openness to discussing issues
that may arise during the field placement 1 2 3 4 5
b. Facilitation of conflict or problem resolution between
the student, field instructor and/or agency 1 2 3 4 5
c. Demonstrated sufficient familiarity with agency policies
and procedures to assist with field instruction 1 2 3 4 5
d. Provision of constructive feedback about your
field teaching abilities 1 2 3 4 5
e. Openness to constructive feedback about his/her
liaison activities 1 2 3 4 5
f. Encouragement of a collegial relationship 1 2 3 4 5
g. Demonstrated sensitivity to issues of privacy
and confidentiality 1 2 3 4 5
8. The Practicum manual was understandable and
user friendly 1 2 3 4 5
9. Are there any specific changes in the practicum process you would like to recommend?
10. What other training experiences would you like to have?
11. Are there any other comments that you would like to make?
College Practicum Instructor/Practicum Director Evaluation

To be completed by the Student
Revised – 2/16/06 3
Bethany College
Social Work Program
Semester, Year: _________________________
College Practicum Instructor: _______________________
Using the following scale, rate the degree to which the College Practicum Instructor:
Poor Fair Average Good Outstanding
1 2 3 4 5
1. Assists students about the integration of theory 1 2 3 4 5

and social work practice
2. Is knowledgeable about both social work 1 2 3 4 5

theory and practice
3. Is able to articulate ideas clearly 1 2 3 4 5
4. Is enthusiastic and stimulating 1 2 3 4 5
5. Is willing to listen to the student’s ideas about 1 2 3 4 5

theory and practice and to discuss
points of disagreement
6. Is clear about expectations 1 2 3 4 5
7. Encourages self-directedness and independence 1 2 3 4 5

appropriate to the student’s experience and abilities
8. Provides feedback to the student regarding 1 2 3 4 5

his/her social work skills and learning needs
9. Is available to the student as a resource person 1 2 3 4 5
10. Treats the student with respect 1 2 3 4 5

11. Serves as arbitrator in any conflicts 1 2 3 4 5
in the field placement
Revised – 2/16/06 4
12. Serves as a positive professional role model 1 2 3 4 5
13. The amount of visits to the agency was:
about right_____ too many_____ not enough_____ Total # of visits_____
14. The assignments for Practicum (-SW 395) and Seminar (-SW 396-) (agency description,
case study, journal, and research project) were helpful learning experiences?
very helpful moderately helpful not helpful_____
Comments:
15. Please comment on things about the Practicum process that you would like to see changed:
Practicum Agency Evaluation

Bethany College Social Work Program
(To be completed by Student)
Revised – 2/16/06 5
Practicum Instructor_____________________________ Placement Semester/Year__________
Agency______________________________________________________________________
Student________________________________________________ Date __________________
Use the scale below to rate the degree to which the stated active took place and/or the
quality of the activity.
1 2 3 4 5
Poor Fair Average Good Outstanding
The Agency
1. Provided sufficient exposure to professional 1 2 3 4 5

social work practice
2. Provided sufficient opportunity for contact 1 2 3 4 5

with clients, client groups, or community
3. Provided a learning experience that was

educational in focus 1 2 3 4 5
4. Provided adequate work space for the

accomplishment of assigned tasks 1 2 3 4 5
5. Provided an adequate orientation that

integrated the student into the agency 1 2 3 4 5
6. Integrated the student into agency meetings

and structured events 1 2 3 4 5
The Practicum Instructor
1. Was generally available when needed 1 2 3 4 5
2. Provided regular weekly supervision

which evaluates learning and encouraged 1 2 3 4 5
professional self-development
3. Seemed familiar with my educational

background and the school’s expectations 1 2 3 4 5
Revised – 2/16/06 6
of practicum
4. Seemed familiar with the educational

objectives and the process of writing 1 2 3 4 5
a contract with students
5. Established rapport easily 1 2 3 4 5
6. Provided clear direction and feed back 1 2 3 4 5
7. Was able to speak with candor about both the

strengths and weaknesses of the student 1 2 3 4 5
8. Was willing to listen to the student’s ideas and

discuss points of disagreement 1 2 3 4 5
9. Assigned tasks that are meaningful and

educationally directed 1 2 3 4 5
10. Encouraged self-directedness and

independence appropriate to the student’s 1 2 3 4 5
experience and abilities
11. Encouraged the student to critically examine

the student’s own performance 1 2 3 4 5
12. Was able to articulate ideas and

expectations clearly 1 2 3 4 5
13. Served as an appropriate professional

role model 1 2 3 4 5
14. Was able to integrate theory and practice so

that it is meaningful to the student 1 2 3 4 5
15. Encouraged me to expand my knowledge

through workshops, books, films, etc. 1 2 3 4 5
16. Was supportive and treated the student with

respect 1 2 3 4 5
17. Treated clients and other staff with respect 1 2 3 4 5
18. Served as and effective mediator and

problem solver 1 2 3 4 5
Revised – 2/16/06 7
19. What aspects of your Practicum experience did you find most valuable?
20. What aspects did you find least valuable?
21. Discuss the recommendation you would give other students regarding this field
placement, including its strengths and weaknesses:
22. Should the agency continue to be used as a field placement agency?
Yes_____ No_____ Yes, with changes (explain)
23. Should the Practicum Instructor be used again for social work students?
Yes_____ No_____ (If no, explain)
Overall Rating of the Placement
Unacceptable Poor Average Good Outstanding

1 2 3 4 5
Revised – 2/16/06 8
Appendix G
COLLEGE POLICIES
CODE OF ETHICS
BSRB FORM
Revised – 2/17/06
Make
duplicates
of hard
copies in
ORIGINAL
practicum
manual
Revised – 2/17/06
Appendix H
BIBLIOGRAPHY
0
BIBLIOGRAPHY
Blake, Richard. Social Work Field Instruction: The Undergraduate Experience. University Press
of America, Lanham, MD, 1985.
Bogo, Marion. The Practice of Field Instruction in Social Work: Theory and Process. University
of Toronto Press, Toronto, 1987.
Bogo, Marion and Power, Roxanne. “New Field Instructors’ Perceptions of Institutional Supports
for Their Roles,” Journal of Social Work Education. Council on Social Work Education,
Alexandria, VA 1992
Collins, Donald; Thomlison, Barbara; and Grinnell, Richard M., Jr. The Social Work Practicum:
A Student Guide. F.E. Peacock, Itasca, Ill., 1992
Engle, Phillip R. Supervision of the Baccalaureate Social Worker. Syracuse University School
of Social Work, Syracuse, NY, 1977
Hamilton, Nina and Else, John F. Designing Field Instruction. Charles C. Thomas, Pub.,
Springfield, Ill., 1983
Manis, Francis. Openness in Social Work Field Instruction: Stance and Form Guidelines.
Kimberly Press, Goleta, CA, 1979.
Rogers, Gayla and McDonald, Lynn. “Thinking Critically: An Approach to Field Instructor
Training,” Journal of Social Work Education. Journal of Social Work Education, Alexandria,
VA, 1992.
Royse, David; Dhooper, Surjit Singh; and Rompf, Elizabeth Lewis. Field Instruction: A Guide for
Social Work Students. Longman, New York, 1993.
Schatz, Mona S., Jenkins, Lowell E., and Sheafor, Gradford W., “Milford Redefined: A Model of
Initial and Advanced Generalist Social Work,” Journal Social Work Education, Vol. 3 Fall, 1990.
Schneck, Dean; Grossman, Bart; and Glassman, Uraina: (ed). Field Education in Social Work:
Contemporary Issues and Trends. Kendall/Hunt Pub, Dubuque, IA, 1991.*
Shulman, Lawrence. Interactional Supervision. NASW Press, Washington, D.C., 1993*
Shulman, Lawrence. Teaching Helping Skills. F.A. Peacock, Inc, Itasca, Ill. 1983.*
Sheafor, Bradford W. And Jenkins, Lowell., (ed). Quality Field Instruction in Social Work:
Program Development and Maintenance. Longman, New York, NY. 1982.*
Wilson, Susanna J. Field Instruction: Techniques for Supervisors. Free Press, New York, NY,
1981.
Urbanowski, Martha L. And Dwyer, Margaret M. Learning Through Field Instruction: A Guide for
Teachers and Students. Family Service America, Milwaukee, WI, 1988.
1
VIDEOS
Shulman, Lawrence. “Core Skills for Field Instructors, Program I: Starting with the Student.”
Shulman, Lawrence. “Core Skills for Field Instructors, Program II: The Student and the Client.”

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Social Work

Plan for Practicum 2

Approval of Practicum Placement 2

Criteria for Becoming an Agency Practicum Instructor 3

Responsibilities of the Agency Practicum Instructor 3

Expectations of the Student 5

The Practicum Process 7

Gatekeeping Role of the Agency Practicum Instructor 9

Practicum Forms and Assignments Related to the student A

Agency Application Forms C

Student Practicum Application D

Stipend/Scholarship or Employment Based Practicum E

Post Practicum Evaluation Forms F

APPROVAL OF PRACTICUM PLACEMENT

CRITERIA FOR BECOMING AN AGENCY PRACTICUM INSTRUCTOR

The following are criteria for becoming an Agency Practicum Instructor:

RESPONSIBILITIES OF THE AGENCY PRACTICUM INSTRUCTOR

The following duties are required in the process of practicum instruction:

1. Participation in training and orientation sessions for agency practicum

2. If a new Field Instructor, attend the seminar of new Field Instructor.

6. Assignment of an appropriate social work caseload and responsibilities to the

a. Involvement with practice activities related to a range of individual, family, group,

b. A significant level of involvement: from initial engagement through conclusion of

c. Case/activity assignments covering a range of diversity of cases. (See learning

d. An assignment dealing with policy awareness/implementation.

e. Assistance in completing a research assignment in evaluation of individual

7. Supervision of work assignments within the agency. In some instances, an agency

8. Provision of practicum instruction. Practicum Instruction differs from task supervision

9. Coordinating with the College Practicum Instructor/Director. The college

12. Completion of follow-up evaluation form on the practicum experience.

EXPECTATIONS OF THE STUDENT

Making the placement

2. Consult with student about placement. (College Practicum Director)

3. Selecting Social Work Placements

Orientation and Beginning of Placement for Practicum Instructor and Student.

1. Pre-practicum training for Practicum Instructor on program objectives and materials.

2. Orientation of Student in the Agency. (Conducted by Agency Practicum Instructor)

Practicum Instruction and Supervision

1. Weekly sessions of practicum instruction with the student. (Agency Practicum

2. Periodic practicum instruction by College Practicum Instructor. (2/semester unless

3. Facilitation of student research project and case study.

E. Assessment of Student Performance

2. Final assessment takes place in the final weeks of practicum.

3. Post semester evaluations by Student and Agency Practicum Instructor are

GATEKEEPING ROLE OF THE AGENCY PRACTICUM INSTRUCTOR

Bethany College social work student (name) ________________________________________,

agree to collaborate in the provision of a social work practicum experience in beginning

Name of Practicum Instructor:___________________________________________

Schedule and Special Conditions

Agency Scheduled Hours:____________________________________________

Educational Plan Review Meeting (Day and Time) _______________________________

Initial Assessment (Day and Time) ___________________________________________

Final Assessment (Day and Time) _________________________________________

Special Conditions and Arrangements (School Holidays, Transportation Arrangements, etc.):

STUDENT LEARNING OBJECTIVES

Objectives for Learning Activities for Implementation Method of Assessment

Objectives for Learning Activities for Implementation Method of Assessment

Objectives for Learning Activities for Implementation Method of Assessment

Systems in The Social Work Process

Special Journal Entry Time Management

F Develop your own material for prioritizing your work.

F Review your copy of the NASW Code of Ethics.

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Will this person be the Practicum Instructor? Yes_ No__