Graduate School of Social Work and Social Research

Transcription

1 Graduate School of Social Work and Social Research APPLICANT Legal Name: (Enter name exactly as it appears on offical documents.) LAST/FAMILY/SURNAME FIRST MIDDLE Preferred name, if not first name: Former name(s), if any: Birthdate: MM/DD/YYYY U.S. Social Security #, if any: Permanent Address: NUMBER AND STREET APARTMENT # CITY/TOWN STATE/PROVINCE COUNTRY ZIP/POSTAL CODE Preferred Phone: Home Cell Home Phone: ( ) Cell: ( ) Address: Mailing Address same as permanent address: Yes No If different from above, please give your current mailing address for all admissions correspondence. Current Mailing Address: NUMBER AND STREET APARTMENT # CITY/TOWN STATE/PROVINCE COUNTRY ZIP/POSTAL CODE Phone at current address: ( ) Use from: MM/DD/YYYY to: MM/DD/YYYY EDUCATION BACHELOR S DEGREE INFORMATION (Please list the institution where you received your undergraduate degree.) : : Other Field of Study, please describe:

2 PLEASE COMPLETE THIS AREA FIRST WITH INSTITUTIONS WHERE YOU RECEIVED A DEGREE OR WERE ENROLLED IN OTHER COURSE WORK. YOU MUST SUBMIT AN OFFICIAL TRANSCRIPT FROM ALL INSTITUTIONS LISTED. IF ADDITIONAL SPACE IS REQUIRED, PLEASE ATTACH AN ADDITIONAL SHEET, IN A SIMILAR FORMAT, TO THIS APPLICATION. If any of your friends or relatives have attended Bryn Mawr or has been associated with Bryn Mawr in some capacity, please indicate. Name: Name: FIRST LAST/MAIDEN/MARRIED RELATIONSHIP TO YOU CLASS AT BRYN MAWR OR OTHER ASSSOCIATION FIRST LAST/MAIDEN/MARRIED RELATIONSHIP TO YOU CLASS AT BRYN MAWR OR OTHER ASSSOCIATION

3 ETHNICITY (Optional) If you wish to be identified with a particular ethnic group, please check all that apply. 1) Are you Hispanic/Latino? Yes, Hispanic or Latino (including Spain) No 2) Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you: American Indian or Alaska Native (including all Original Peoples of the Americas) Are you Enrolled? Yes No If yes, please enter Tribal Enrollment Number Asian (including Indian subcontinent and Philippines) Black or African American (including Africa and Caribbean) Native Hawaiian or Other Pacific Islander (Original People) White (including Middle Eastern) Other (If Other, please specifiy): GENDER (Optional) Female Male CITIZENSHIP (Required) US Citizen Dual US Citizen US permanent resident visa (Alien registration # ) Other citizenship (Visa type ) List any non-us countries of citizenship How many years have you lived in the United States? Place of birth: CITY/TOWN STATE/PROVINCE COUNTRY U.S. Armed Services Veteran? Yes No DISCIPLINARY HISTORY (Required) 1. Were you ever the recipient of any action by any college for a) unacceptable academic performance or b) conduct violations, even if such action did not interrupt your enrollment or require you to withdraw? Yes No If yes, explain fully on a separate document and attach to this application. 2. Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? Yes No (Note that you are not required to answer yes to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.) If you answered yes, explain fully on a separate document. Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience and attach to this application.

4 DEGREE PROGRAM Please indicate the degree program to which you are applying. MSS MSS Advanced Standing MSS/MPH dual degree program through Thomas Jefferson University/Jefferson School of Population Health (I am currently enrolled in the MPH Program at Jefferson) MSS/MPH dual degree program through Thomas Jefferson University/Jefferson School of Population Health (I am NOT currently enrolled in the MPH Program at Jefferson) PhD Please note that students interested in the MSS/MPH dual degree program who are not already enrolled in Thomas Jefferson University/ Jefferson School of Population Health s MPH program must apply separately for the MPH after enrolling at Bryn Mawr as full-time students. All applicants to the MSS degree program, please indicate the concentration in which you are most interested. If you are uncertain at this time, feel free to select Undecided. Direct Practice/ Clinical Social Work Community Practice/ Policy, Practice and Advocacy Undecided Enrollment Status Full-time Part-time Are you a transfer student? Yes No Entry Year and Term Have you previously applied to this program? Yes No OTHER SCHOOLS what other graduate school programs are you applying? UNIVERSITY DEPARTMENT UNIVERSITY DEPARTMENT

5 SOURCE OF INTEREST How did you learn about the Bryn Mawr Graduate School of Social Work and Social Research? (Please check all that apply.) Bryn Mawr College Web Site BMC Alumnae/i BMC Faculty Member BMC Current Student Faculty Member Employer/Supervisor/Co-worker Graduate School Career Fair Printed Directory of Graduate Programs Career Development Office Journal or Magazine Printed Mailing/Brochure Other Website (please specify): Other (please specify): RESUME OR CURRICULUM VITAE (CV) Please attach your current resume or curriculum vitae (cv) to your application. Answer the questions below and attach them to your application. Your name should be typed in the upper right-hand corner of each page. ESSAY QUESTIONS 1. Personal Statement All applicants must answer both a) and b). a) Discuss your reasons for pursuing a graduate degree in social work and discuss those personal, vocational and educational experiences that have influenced your career goals; and b) What are your strengths and weaknesses and how have do you anticipate they will affect your role as a professional social worker? 2. Program Specific Questions Respond to either a) or b) depending on the program to which you are applying. a) For Non-Advanced Standing Students Only: Choose a social problem in which you are vitally interested. Identify the factors that must be considered in order to develop a policy or program that addresses this problem. Students with an interest in the MSS/MPH dual degree program may wish to select a social problem related to public health. b) For Advanced Standing Students Only: The assessment of individual and family functioning is a complex process. Consider the case the Washington family, and respond to the following issues. Identify the major psychosocial stressors, risks, and protective factors present within this family. Identify an intervention model and apply it to this case. Formulate a plan to evaluate your work with this family. Fifteen-year-old Anthony Washington was referred to the community mental health clinic by the courts as a result of repeated incidences of shoplifting and truancy. Keisha and Malcolm Washington are Anthony s parents. They are African American, have been married for sixteen years, and live in a largely African-American, lower middle class community in an urban area. Keisha s father, who was an alcoholic who physically abused his wife, died several years ago; she is close to her mother and two sisters and together they attend the Baptist church to which they have belonged for years. Malcolm and his twin brother were raised in a series of foster families and lost contact with their parents, both of whom were addicted to cocaine. When Malcolm s brother was killed in a car accident two years ago, Malcolm experienced his first depressive episode for which he was treated with medication. Keisha has worked as a bank teller for five years; Malcolm, who worked in construction for the past fifteen years, was laid off nine months ago and currently is unemployed. Initially, Malcolm sought another job, but about three months ago, he stopped looking for employment and began drinking heavily. He has become increasingly belligerent and on at least one occasion, punched Keisha with his fist. Anthony, who is dyslexic and has struggled in school, has never been in any real trouble either in school or the community. He recently began hanging out with a tough group of neighborhood kids and a few months ago was picked up by police for shoplifting. Keisha made restitution for the stolen items but when she attempted to ground Anthony, Malcolm angrily told her to get off his back and blew off the behavior as typical adolescent stuff. Unfortunately, Anthony s delinquent behavior accelerated and he has been picked up a number of times for truancy and underage drinking.

6 FINANCIAL AID Admissions decisions are made independent of financial aid considerations. institutional financial assistance awarded directly by Bryn Mawr College is based on a combination of academic promise and financial need. You may also be eligible for federal loan programs, which requires completion of the Free Application for Federal Student Aid (FAFSA). Because institutional resources are limited, students are expected to use personal, family, and loan resources to the fullest extent possible. Please complete the following in full to be considered for institutional grant awards. Should your circumstances change, you must notify Bryn Mawr s Office of Admission in writing. Do you intend to apply for financial assistance? Yes No Have you completed the Free Application for Federal Student Aid (FAFSA)? Yes No I have not but am planning to do so How do you plan on covering the costs of tuition and fees (please complete the sections below to the best of your ability): Personal and/or family funds/savings $ Tuition Benefit (employer/agency funding) $ Estimated loans from the federal government $ Estimated institutional grant aid you will need from Bryn Mawr College $ Outside scholarships (including, but not limited to armed forces) $ Other $ Assets (including spouse s if applicable): tal balance of cash, checking, and savings accounts: $ tal amount of trust funds: $ tal net worth of investments (do not include retirement accounts): $ Expected monthly gross income of student (and spouse, if applicable) during time of graduate school enrollment: $ Student Loan Debt: Please indicate total current student loan indebtedness (undergraduate, graduate, and professional school loans combined): $ Enrollment Plans: The amount of grant and loan aid you are eligible to receive is directly related to the number of courses you take each term. Please be as accurate as possible when completing this section. How many courses (i.e., 2, 4, 5, etc.) will you take for each of the three terms below? include field placement in your count. Summer 2016 Fall 2016 Spring 2017 REQUIRED SIGNATURE I certify that all information submitted in the admission process including the application, the personal statement/s, any supplements, and any other supporting materials is my own work, factually true, and honestly presented. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I ve certified be false. Applicant s Signature: Date: