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. Field Instruction Placement Forms

     Field Placement Questionnaire for Foundation/1st Year
     PM Program Foundation Year Field Instruction Questionnaire
     PM Field Instruction Confirmation Form
     Liability Insurance Form

2. Foundation Field Forms

     Calendar 2009-2010
     Learning Contract
     Student Self-Assessment 1st
     Semester Grade Report SocW570 FI I
     Evaluation of Practice Assignment
     Student Self-Assessment 2nd
     Semester Grade Report SocW571 FI II
     Student's Evaluation of Agency Field Placement
     Student's Evaluation of Faculty Field Liasion Service
     Agency Field Instructor Evaluation's of Faculty Field

PM Student Calendars

January Start
Summer Block

3. Concentration Year Field Forms

a) SCH Field Forms

     School Calendar 2009-2010
     Learning Contract
     Student Self-Assessment 1st
     Semester Grade Report SocW572 FI III
     Evaluation of Practice Assignment
     Student Self-Assessment 2nd
     Semester Grade Report SocW573 FI IV
     Student's Evaluation of Agency Field Placement
     Student's Evaluation of Faculty Field Liasion Service
     Agency Field Instructor Evaluation's of Faculty Field
     Safety and Technical Standards - Ack of Capacity for Prof
     Criminal and Criminal Ack Form

b) CHUD Field Forms

     Calendar 2009-2010
     Learning Contract
     Student Self-Assessment 1st
     Semester Grade Report SocW572III 1st
     Evaluation of Practice Assignment
     Student Self-Assessment 2nd
     Semester Grade Report SocW573 IV 2nd
     Student's Evaluation of Agency Field Placement
     Student's Evaluation of Faculty Field Liasion Service
     Agency Field Instructor Evaluation's of Faculty Field

c) MH Field Forms

     Calendar 2009-2010
     Learning Contract
     Student Self-Assessment 1st
     Semester Grade Report SocW572III 1st
     Evaluation of Practice Assignment
     Student Self-Assessment 2nd
     Semester Grade Report SocW573 IV 2nd
     Student's Evaluation of Agency Field Placement
     Student's Evaluation of Faculty Field Liasion Service
     Agency Field Instructor Evaluation's of Faculty Field

d) CHF Field Forms

     Calendar 2009-2010
     Learning Contract
     Student Self-Assessment 1st
     Semester Grade Report SocW572III 1st
     Evaluation of Practice Assignment
     Student Self-Assessment 2nd
     Semester Grade Report SocW573 IV 2nd
     Student's Evaluation of Agency Field Placement
     Student's Evaluation of Faculty Field Liasion Service
     Agency Field Instructor Evaluation's of Faculty Field

4. Guidelines & Educational Agreement for Place of Employment Form

5. Overview of Concentration Selection 2009-2010. These are not exhaustive lists of field placement agencies.

Planning Your MSW Concentration
CHF Agencies
CHUD Field Agencies
MH Field Agencies
SCH Field Agencies

6. Overview of Foundation Selection 2009-2010. This is not an exhaustive list of field placement agencies.

Foundation Agencies

7. Information Packet for Prospective Field Placement Agencies

Information Packet for Prospective Field Placement Agencies
Agency Application Form
Field Instructor Application Form
Agency Update Form

To download the manuals in PDF format, please be sure that you have the Adobe Acrobat Reader, which is free. If you need to download the Reader program, click the Reader icon.

Field Instruction Manuals and all 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.