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UHD Social Work Field ManualField Practicum Liability InsuranceField Form #3Prior to entering your field practicum site, you must apply and successfully receive student fieldliability insurance through the National Association of Social Workers’ (NASW) StudentProfessional Liability Insurance Program, and you must maintain coverage for the entire 400hours required for your practicum (200 hours to be completed in each long semester). To meetthis hour requirement, you are allowed to work 15-20 hours per week at your practicumlocation. You may begin your practicum hours no sooner than August 15th (with the exceptionof a mandatory agency training requirement), and you may complete your hours no sooner thanMay 1st.The cost for your coverage in field is low because your coverage is supported by the NASWTrust. Therefore, you must also become a student member of NASW.Step 1: Join NASW at the student member rate of 44.00 for one lt.aspStep 2: Apply for your liability insurance (you can do this as soon as you receive yourNASW member number) and choose your preferred level of coverage ranging from 23.00 41.00 for one year (the lowest level of coverage is -StudentPLIApplication-07-18-07.pdfStep 3: By May 1st, email an electronic copy of this signed form and a copy of your proofof liability coverage to the Field Director, Dr. McCarty at mccartyd@uhd.edu.This process must be completed by the May 1st deadline. Please acknowledge below that youunderstand that you cannot enter your field practicum unless you have successfully receivedStudent Professional Liability Insurance.I understand that I cannot enter field practicum unless I have successfully receivedStudent Professional Liability Insurance coverage. Y NPrinted name:Date:Page 53 / FM2011/12
UHD Social Work Field ManualField Agency Information FormAll agencies selected for field experience must: 1) share a mission compatible with theUniversity, 2) provide adequate work access and opportunity for the student to achieve thegoals and objectives of the Social Work Program, 3) engage in work that is compatible with theoverall purposes of the social work profession, and 4) provide a site that is sensitive to and ableto accommodate any special learning or access needs of the student.*All UHD BSW students will be covered by the National Association of Social WorkersStudent Professional Liability Insurance Program: plication-07-18-07.pdf.If your agency would like to be considered as a field practicum site, as a 1st step in theapplication process, please complete the following questionnaire:1. Agency name and address:2. Possible locations for field sites:3. Type of services that the agency provides:Page 54 / FM2011/12
UHD Social Work Field Manual4. How long in operation: Brief history of the agency:5. Do you offer a stipend or any other forms of student support: Yes NoIf yes, please list here. If no, please indicate if you are open to providing a stipend. Yes No6. What specific experiences could students have in your agency:Page 55 / FM2011/12
UHD Social Work Field Manual7. Briefly describe the hours and days of the week a BSW student could work undersupervision in your agency. Flexible schedules are greatly valued.8. Does your agency require:Physical examTuberculosis (TB) testProof of immunizationDrug testingProof of US citizenshipProof of legal residence (Student Visa or Green card):State central registry child abuse clearanceCriminal background checkFinger ONO9. Does your agency have staff that meet the following criteria:a) Hold a CSWE accredited Bachelor or Master’s Social Work Degree or toaccommodate special or unusual opportunities where unique learning opportunitiesexist, the program may accept persons with other than social work training to assumethe role of field supervisor. In these circumstances, the field supervisor must have aBachelor’s Degree and or Master’s degree in a related field (psychology, criminaljustice, etc.) and the agency’s mission and delivery of services must be compatiblewith social work values. Y NPage 56 / FM2011/12
UHD Social Work Field Manualb) Have two years of social or public service practice experience, with at least one yearof tenure at their current job. Y Nc) Have a history of and current commitment to the core values of the social workprofession including service, social justice, dignity and worth of the person,importance of human relationships, integrity, and competence. Y Nd) Have the capacity to teach and guide student learning and experiences throughsupportive mentorship, from a strengths perspective. Y Ne) Help foster a commitment to lifelong learning and effective use of supervision. Y Nf) Attend field supervisor orientations, meetings and trainings. Y Ng) Complete all student learning evaluation forms. Y Nh) Be available for consultation with UHD Field Director. Y N10. If no to any of the above, is there a possiblity of an off site supervisor? Y NPage 57 / FM2011/12
liability insurance through the National Association of Social Workers’ (NASW) Student Professional Liability Insurance Program, and you must maintain coverage for the entire 400 hours required for your pra
