University of Wisconsin Green Bay MSW Program Child Welfare Education & Advancement Program

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1 University of Wisconsin Green Bay MSW Program Child Welfare Education & Advancement Program MSW Child Welfare Stipend Program Application & Contract (Public child welfare agency employee) Note: This application must be filled out and printed. You can enter your responses in the form, print it, and mail or deliver it to the Child Welfare Coordinator. Attach your signed contract to the application form. Name: Telephone: Current mailing address: If you have a UW GB address University Child Welfare Program Orientation: Applicants must attend one program orientation session. To register: Child Welfare Coordinator at mattilam@uwgb.edu UW Green Bay: Tuesday, March 24, 2015, 4:00 5:00 PM, Rose Hall 305 Practice interest: (select one): Direct services Administration (program coordination, supervision, training, etc.) Please respond to the following questions. Please limit your responses to the space available. Do not cut and paste text into the boxes. 1) The UW Green Bay MSW program prepares students for advanced social work practice, either in direct (micro-level) or administrative (macro-level) roles. Describe how your achievement of the MSW degree would benefit: The children and families served by your agency:

Attach your signed contract to the application form.

2 Describe how your achievement of the MSW degree would benefit: Your employing agency: Describe how your achievement of the MSW degree would benefit: The community (county, tribal) that your agency serves: 2) Describe your commitment to culturally competent social work practice. Illustrate this commitment with examples of your own experiences with people who are of diverse racial, ethnic or cultural backgrounds.

Describe your commitment to culturally competent social work practice.

3 3) Please describe your professional social work career goals and articulate how participation in the MSW child welfare training program would assist you in achieving these goals. Contract: Applicants must review the MSW Title IV-E Child Welfare Stipend Program Guidelines and Contract (last page of this form): Date contract reviewed and signed: Submit a hard copy of this application and your signed contract to the Child Welfare Coordinator by Monday, April 6, Applicants may be asked to attend an interview as part of the application process. Reminder: keep a copy of both the application and contract for yourself! Child Welfare Coordinator: Matthew Mattila, ACSW, UWGB Social Work Program, 2420 Nicolet Dr., RH-320, Green Bay, WI mattilam@uwgb.edu Revised 09/14

application and your signed contract to the Child Welfare Coordinator by Monday, April 6, 2015. Applicants may be asked to attend an interview as part of the application process.

4 CONTRACT For University of Wisconsin Green Bay Master of Social Work Program Child Welfare Education & Advancement Program This contract is executed by and between hereinafter referred to as the Participant, and the UW Green Bay MSW Program, hereinafter referred to as the Program, for the provision of a Child Welfare Education & Advancement Program Stipend. This contract takes effect as of JUNE 15, 2015 and supersedes and takes precedence over any existing Contract by and between the parties. This Contract is contingent upon the continuation of federal and state funding. The Program agrees to provide the Participant with the following: 1. A stipend equivalent to the cost of graduate, in-state tuition and fees, for: Advanced Year (Fall & Spring Semesters and 6 credits Summer Semester) Part-Time Tuition Full-Time Tuition 2. Information about qualified employment opportunities in Wisconsin public, tribal and community partner child welfare agencies. The Participant agrees to the following terms and commitments: 1. Demonstrate an emphasis in child welfare practice in course and field work. 2. Remain in good academic standing. 3. Participate in program orientations and meetings arranged by the Child Welfare Coordinator. 4. Read, understand and comply with all Child Welfare Education Program Guidelines and attached forms. 5. Upon graduation, submit documentation of availability for qualified employment. 6. For one year after graduation, submit documentation of search for qualified employment, and, apply for and accept the first offer of qualified employment in the field of public or tribal child welfare within the NE Wisconsin region comprised of the 26 NEW Partnership counties: 7. For a one-year period after obtaining full-time qualified employment, remain employed in that position for at least one year (12 months) for each year stipend funds are received.

This contract takes effect as of JUNE 15, 2015 and supersedes and takes precedence over any existing Contract by and between the parties.

5 8. If currently employed by a public child welfare agency, retain full-time employment in this agency for a one-year period for each year stipend funds are received. 9. For a three-year period after graduation, provide the Child Welfare Coordinator with current contact and employment information. 10. Remain in good standing with the employer during the repayment period, and: 11. Reimburse the full amount of stipend funds received within 90 days if determined to be in default, as defined in the Program Guidelines. The Contract will be considered to be completed when one of the following conditions is met: The participant fulfills their post-graduation employment commitment in a qualified public, tribal or community partner child welfare agency, or; The stipend recipient reimburses the full amount of stipend funds received, or; The stipend recipient is granted a waiver of their post-graduation employment commitment. Participants will receive written notice when they have fulfilled the requirements of their contract. Signature by the Participant confirms that they have reviewed and will comply with the MSW Program Guidelines. MSW Student Participant Child Welfare Coordinator UW Green Bay MSW Program Date Date Attachments: Available online in Program Guidelines document at: A. CWEAP Program Guidelines B. Initial Graduate Report C. Employment Search Report D. Self-Referral for Stipend Reimbursement E. Request for Extension / Waiver of Employment Obligation F. Request for Alternate Plan for Post-Graduation Employment Commitment Revised 03/15

Remain in good standing with the employer during the repayment period, and: 11.

Attachment A. PROGRAM GUIDELINES For Bachelor of Social Work (BSW) Child Welfare Education Program

Attachment A. PROGRAM GUIDELINES For Bachelor of Social Work (BSW) Child Welfare Education Program Attachment A PROGRAM GUIDELINES For Bachelor of Social Work (BSW) Child Welfare Education Program The Child Welfare Education Program (CWEP) is a partnership between the Wisconsin Division of Children