Field Practicum Liability Insurance Field Form #3

Transcription

1 Field Practicum Liability Insurance Field Form #3 Prior to entering your field practicum site, you must apply and successfully receive student field 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 practicum (200 hours to be completed in each long semester). To meet this hour requirement, you are allowed to work hours per week at your practicum location. You may begin your practicum hours no sooner than August 15 th (with the exception of a mandatory agency training requirement), and you may complete your hours no sooner than May 1 st. The cost for your coverage in field is low because your coverage is supported by the NASW Trust. Therefore, you must also become a student member of NASW. Step 1: Join NASW at the student member rate of $44.00 for one year: Step 2: Apply for your liability insurance (you can do this as soon as you receive your NASW member number) and choose your preferred level of coverage ranging from $ $41.00 for one year (the lowest level of coverage is sufficient): Step 3: By May 1 st, an electronic copy of this signed form and a copy of your proof of liability coverage to the Field Director, Dr. McCarty at mccartyd@uhd.edu. This process must be completed by the May 1 st deadline. Please acknowledge below that you understand that you cannot enter your field practicum unless you have successfully received Student Professional Liability Insurance. I understand that I cannot enter field practicum unless I have successfully received Student Professional Liability Insurance coverage. Y N Printed name: Date: Page 53 / FM

2 Field Agency Information Form All agencies selected for field experience must: 1) share a mission compatible with the University, 2) provide adequate work access and opportunity for the student to achieve the goals and objectives of the Social Work Program, 3) engage in work that is compatible with the overall purposes of the social work profession, and 4) provide a site that is sensitive to and able to accommodate any special learning or access needs of the student. *All UHD BSW students will be covered by the National Association of Social Workers Student Professional Liability Insurance Program: StudentPLIApplication pdf. If your agency would like to be considered as a field practicum site, as a 1 st step in the application 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 / FM

3 4. How long in operation: Brief history of the agency: 5. Do you offer a stipend or any other forms of student support: Yes No If yes, please list here. If no, please indicate if you are open to providing a stipend. Yes No 6. What specific experiences could students have in your agency: Page 55 / FM

4 7. Briefly describe the hours and days of the week a BSW student could work under supervision in your agency. Flexible schedules are greatly valued. 8. Does your agency require: Physical exam Tuberculosis (TB) test Proof of immunization Drug testing Proof of US citizenship Proof of legal residence (Student Visa or Green card): State central registry child abuse clearance Criminal background check Finger Printing 9. Does your agency have staff that meet the following criteria: a) Hold a CSWE accredited Bachelor or Master s Social Work Degree or to accommodate special or unusual opportunities where unique learning opportunities exist, the program may accept persons with other than social work training to assume the role of field supervisor. In these circumstances, the field supervisor must have a Bachelor s Degree and or Master s degree in a related field (psychology, criminal justice, etc.) and the agency s mission and delivery of services must be compatible with social work values. Y N Page 56 / FM

5 b) Have two years of social or public service practice experience, with at least one year of tenure at their current job. Y N c) Have a history of and current commitment to the core values of the social work profession including service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. Y N d) Have the capacity to teach and guide student learning and experiences through supportive mentorship, from a strengths perspective. Y N e) Help foster a commitment to lifelong learning and effective use of supervision. Y N f) Attend field supervisor orientations, meetings and trainings. Y N g) Complete all student learning evaluation forms. Y N h) Be available for consultation with UHD Field Director. Y N 10. If no to any of the above, is there a possiblity of an off site supervisor? Y N Page 57 / FM