Welcome to the USC Suzanne Dworak-Peck School of Social Work!

For incoming students:

In order for you to be placed in an MSW internship, you will need to complete and submit this entire Online Field Placement Form within five days of receiving your intent to enroll form. Your intent to enroll/enrollment confirmation form (including Field Education Contract and Background and Clearance Form), commitment deposit, and this field form are required to secure your place in the upcoming class.

For continuing students:

In order for you to be placed in an MSW internship, you will need to complete and submit this entire online Field Placement Form in a timely manner; otherwise, your field placement may be delayed and your ability to ultimately graduate with your cohort may be negatively impacted.

Please complete all areas, as this information will be used to guide the Field Education Placement Team in developing your community-based field placement. Some of this information will also be sent to your assigned Field Instructor to assist in planning your educational experience.

If you have any further questions, email sswfield@usc.edu. If there are any changes to your academic year address, please contact the Field Education Department at sswfield@usc.edu.

Thank you for taking the time to complete this form thoroughly. We look forward to working with you in the MSW program. Fight on!

Please enter your 10 digit USC ID (no dashes or spaces):

Re-enter your USC ID (no dashes or spaces):

First Name:

Last Name:

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Military Affiliation

Are you currently affiliated with the military?

YesNo

If Yes, please select type of affiliation.

Which Branch?

Do you currently reside on a military base?

YesNo

If Yes, Which base?

Education Summary

Undergraduate Degree Institution:

Undergraduate Major:

Undergraduate Degree Date (mm/yyyy):

Other Advanced Degree Institution:

Other Advanced Degree Major:

Other Advanced Degree Date (mm/yyyy):

Work Experience

Please list and briefly describe previous experience (volunteer and paid) related to social work. The information requested below will assist in the planning of your field assignment. Please also include a copy of your current resume. Your resume and field application will be shared with potential placement site(s).

Experience 1: Agency Name, Volunteer or Paid, Position or Duties / Dates of Service

Experience 2: Agency Name, Volunteer or Paid, Position or Duties / Dates of Service

Experience 3: Agency Name, Volunteer or Paid, Position or Duties / Dates of Service

Experience 4: Agency Name, Volunteer or Paid, Position or Duties / Dates of Service

Field Placement Schedule

Field placement days for on-campus program MSW students are generally on Mondays and Wednesdays from 8 am to 5 pm. Some agencies may require an alternative schedule.

I understand

Do you have any special circumstances that may impact your ability to complete your field placement (for example, family responsibilities, physical or health challenges, medications, learning disabilities, and other areas as identified)? **Important note: Lack of timely disclosure of special circumstances may not only create significant delays in placement, but may require you to take a Leave of Absence and/or delay your anticipated graduation.

YesNo

Please describe below. This information will not be provided to your placement agency; however, you are encouraged to share this information with the agency during the pre-placement meeting if you think it might impact your performance as an intern.

Do you have any background clearance issues (DUI, expunged records, convictions, etc.) that may affect placement in an agency that does background checks? Any information not disclosed at this time of application for placement may affect your ability to be placed and/or to remain in your placement.

YesNo

The following is a list of populations and clinical issues that you may be working with during your field placement: adolescents, adult women, adult men, children and families, older adults, AIDS, Alzheimer's, cancer, child abuse, child and family protective services, corrections/criminal, developmental disabilities, domestic violence, emotionally disturbed children and/or adolescents, family service, LGBT, health/medical, homelessness, juvenile delinquency, mental health, public social services, severe mental illness, social work in schools, substance abuse and veterans.

Please indicate any gender, racial/ethnic group, populations, or issue(s) in which you have a particular interest that is related to your concentration. This information aids in planning your placement, although we cannot guarantee a placement in these areas.

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Personal Statement

This personal statement asks for additional and different information than the personal statement you submitted with your original admissions application. Please share information which we can use to plan your field education experience.
1. Provide an introduction of yourself.
2. Articulate why you chose social work. Include personal and professional experiences which have influenced your decision to pursue an advanced degree in social work.
3. Describe your expectations for your field placement; discuss particular interests, strengths, and limitations and how they might affect your ability to work with clients.
4. Identify any individual learning goals and your career focus.

Please be as detailed as possible. (5,000 character limit. You may copy and paste.)

Personal Statement

Please upload your resume:

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Personal Information

Emergency Contact

Language Fluency

Transportation

Military Affiliation

Education Summary

Work Experience

Field Placement Schedule

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Personal Statement