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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.

     Foundation Field Instruction Questionnaire/1st year
     Concentration Field Instruction Questionnaire/2nd year
     Field Instruction Confirmation Form
     Change of Field Instructor Form    
     Liability Insurance Form    
     Place of Employment Form & Guidelines
     Trouble-shooting Field Forms
     Information for the Field Foundation Student
     Information for the Field Advanced Standing Student

2. PM Extended Study Foundation Spring 2015
(For PM Student starting January 2015)

     PM Spring Calendar 2015
     Learning Plan
     Student Self-Reflection 1st
     Semester Evaluation 1st
     Evaluation of Practice Proposal
     Evaluation of Practice Assignment
     Student Self-Reflection 2nd
     Semester Evaluation 2nd
     Student Evaluation of Liaison Services
     Field Instructors Evaluation of Faculty Field Services
     Student Evaluation of Agency/Field Placement

3. PM Extended Study Foundation Summer 2015
(For PM students starting May 2015)

4. PM Extended Study Program 2014-2015 Field Placement Information

     PM Extended Study Program Information for the Field/1st Year PM students

     PM Extended Study Program Information for the Field/2nd Year PM students

5. Field Forms

     Foundation Field Forms

     Calendar 2014-2015
     Learning Plan
     Evaluation of Practice Proposal
     Student Self-Reflection 1st
     Semester Evaluation 1st Semester
     Evaluation of Practice Assignment
     Student Self-Reflection 2nd
     Semester Evaluation 2nd Semester
     Student Evaluation of Liaison Services
     Field Instructors Evaluation of Faculty Field Services
     Student Evaluation of Agency/Field Placement

     Concentration Field Forms

     Concentration Calendar 2014-2015
     School Concentration Calendar 2014-2015
     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
     Semester Evaluation 1st Semester - Child & Family
     Semester Evaluation 1st - Community Health & Urban Development (CHUD)
     Semester Evaluation 1st Semester - Mental Health
     Semester Evaluation 1st Semester - School
     Evaluation of Practice Assignment
     Student Self-Reflection 2nd
     Semester Evaluation 2nd Semester - Child & Family
     Semester Evaluation 2nd - Community Health & Urban Development (CHUD)
     Semester Evaluation 2nd Semester - Mental Health
     Semester Evaluation 2nd Semester - School
     Student Evaluation of Liaison Services
     Field Instructors Evaluation of Faculty Field Liaison Services
     Student Evaluation of Agency/Field Placement


     Prof. Bennett's Evaluation of Practice Assignment Seminar

6. Foundation and Concentration Selections: These are not exhaustive lists of field placement agencies.

     Agency Search Tool

7. 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

8. Agency Forms and Information

     Agency Information for Prospective Field Placement Agencies
     Field Instructor Application Form
     Agency Application
     Task Supervisor Contract

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

 

To download the manual in PDF format, you will need Adobe Acrobat Reader, which is free. To download, click the Reader icon.

go to MSW & Pos-MSW field manual     icon of Adobe Acrobat Reader