Placement Opportunity Application Form
Thank you for your interest in becoming a field placement site for the PSU School of Social Work. Our students spend 16 hours/week in their field placements and must be supervised by qualified field instructors. Please see the PSU School of Social Work's qualifications of Field Agencies and Field Instructors.
INSTRUCTIONS: Please complete this form on your computer, then press the SEND INFORMATION button at the bottom of the form. This emails your application to the PSU School of Social Work.
Brief Program Description:
Will you be the field instructor (requires SW degree) for this placement?
If no, please identify who the field instructor will be.
How many PSU students can your program host?
More than 3
Are you willing to hold these spaces for PSU Social Work students?
Can you host an Advanced Standing Student? (Advanced Standing students begin their field placement in the summer and continue through the following June)
What sequence(s) can your organization accommodate? (Please see Practice Sequence and Concentration Descriptions).
Generalist (BSW and MSW 1st Year)
Practice & Leadership with Communities and Organizations
Health Across the Lifespan
Children, Youth, and Familes
Clinical Social Work Practice
Fields of Practice -- please check all that apply:
Corrections / Criminal Justice
Family Services / Parenting and Early Childhood
Immigrants and Refugee Services
Public Assistance / Self Sufficiency (not Child Welfare)
School Social Work
Services to Veterans / Families
Primary Service Area
The Council on Social Work Education (CSWE) requires us to annually report the types of services provided by our field agencies. Please choose the one (1) category that best describes your agency's work.
Aging/Gerontological Social Work
Alcohol, Drug, or Substance Abuse
Domestic Violence or Crisis Intervention
Mental Health or Community Mental Health
Military Social Work
Public Assistance/Public Welfare (not Child Welfare)
School Social Work
Other (Please specify in text box below)
Population(s) served -- please check all that apply:
Are bilingual students preferred?
Are bilingual students required?
If bilingual students required, what language(s)?
Are evening hours available?
Are there regular social services offered on the weekends that would allow a student to complete a majority of their 16 hours/week placement during the weekend?
Does this placement require a driver's license?
Does this placement require a car?
Please check the appropriate box: (Your application will be e-mailed to the correct program option).
Distance Option - Ashland, Central Oregon, Eugene, Salem Cohorts (Jessica Hayes)
Portland Campus Program (Jessica Hayes)
Online Program (Jessica Hayes)
Thank you for taking the time to complete this form!