Downloadable Forms for Students and Field Instructors

All forms submitted must be original. They may be submitted either in person or via mail.

Field Instruction Division
Jane Addams College of Social Work
1040 W. Harrison (M/C 309)
Chicago, IL 60607-7134

1. Electronic field instruction placement forms for Foundation Year and PM students.
These can be completed on a computer, printed for mailing, faxing or sending as an email attachment.

     Field Placement Questionnaire for Foundation/1st Year
     PM Extended Study Program Foundation Year Field Instruction Questionnaire
     Field Instruction Confirmation Form
     Liability Insurance Form
     (POE) Guidelines & Educational Agreement for Place of Employment Form
     Guidelines to using the Learning Plan

2. PM Extended Study Program 2012-2013 Field Placement Information

PM Extended Study Program Field Placement Information Packet / 1st Year PM students

PM Extended Study Program Field Placement Information Packet / 2nd Year PM students

3. Foundation Field Forms

     Calendar 2012-2013
     Learning Plan
     Student Self-Reflection 1st
     Evaluation of Practice Proposal
     Evaluation of Practice Assignment
     Student Self-Reflection 2nd

Qualtrics Forms:

Students will be emailed a link: Student Self-Assessment 1st

     For Field Instructors: PDF of 1st Semester Evaluations

     1st Semester Child Family Student Evaluation
     1st Semester CHUD Student Evaluation
     1st Semester Foundation Student Evaluation
     1st Semester Mental Health Student Evaluation
     1st Semester School Student Evaluation

4. Concentration Field Forms

     Concentration Calendar 2012-2013
     School Concentration Calendar 2012-2013
     School Site Visit Sheet
     Learning Plan - Child & Family
     Learning Plan - Community Health & Urban Development (CHUD)
     Learning Plan - Mental Health
     Learning Plan - School
     Student Self-Reflection 1st
     Evaluation of Practice Proposal
     Evaluation of Practice Assignment
     Student Self-Reflection 2nd

   Qualtrics Forms:

     Students will be emailed a link: Student Self-Assessment 1st

Prof. Bennett's Evaluation of Practice Assignment Seminar

5. Foundation and Concentration Selections: 2012-2013. These are not exhaustive lists of field placement agencies.

Agency Search Tool

6. School Social Work Orientation Forms

     Criminal Offenses and Background Check
     Safety and Technical Standards: Acknowledgment of Capacity for Professional Education and Social Work
     United States Citizenship

7. Prospective Agency Applications and Information

     Agency Information for Prospective Field Placement Agencies
     Agency Application Form
     Field Instructor Application Form
     Agency Data Form

Field forms are also available from the JACSW Office of Field Instruction, fourth floor, ECSW, Jane Addams College of Social Work, Office of Field Instruction, 1040 W. Harrison Street, Chicago, IL 60607.