Fillable BSW App 6-27-2017

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BSW App 6-27-2017

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Revised 6/27/2017
Name
Student Steps of Responsibility for
admission to the Wichita State University
BSW Program and Practicum Program
Description of Steps
Attend a BSW Program Orientation as early
into your major as you can.
These are held twice a year, as part of the Social Work Friday event at the WSU
School of Social Work. Students are required to attend one orientation before they
can be admitted into the social work program.
Meet with Shaunna Millar, BSW Program
Director as early into your major as you can.
Call 316-978-7250 to schedule a meeting time to discuss your progress into the
Social Work program. In this meeting, a class plan for your future semesters will be
discussed.
Apply to the BSW Program and Practicum
when you have met the minimum criteria.
Complete the attached application and forms. There are two deadline dates per year
– December 1 and July 1. Applications are reviewed by the BSW Admissions
Committee, and students are notified of their entrance status into the program. Forms
are also available online at www.wichita.edu/socialwork.
Attend a practicum program orientation in the
fall of your junior year.
These are held in the fall semester, as part of the Social Work Friday event at the
WSU School of Social Work. Students are required to attend orientation as part of
their practicum process.
Complete your Senior Form/Application for
Graduation with your social work faculty
advisor.
Meet with your assigned social work advisor to complete this form in the fall semester
of your junior year. If you’re unsure who your assigned advisor is, please call the
WSU School of Social Work office at 978-7250 or an email to
socialwork@wichita.edu.
Complete your Senior Form/Application for
Graduation with LAS Advising.
Schedule a time to meet with an advisor in the LAS Advising Center -
www.wichita.edu/lasadvising.
Complete a practicum inventory and submit
your resume in the fall of your junior year.
The practicum inventory provides the Director of Field Practicum and the Associate
Director of Field Practice information on your interests and availability for practicum.
This form is available at the practicum orientation. The form is also available online at
www.wichita.edu/socialwork. These are due by December 1 in the School office,
along with a copy of your resume.
Schedule your campus interview for practicum
in December of your junior year.
Call our office 316-978-7250 or stop by the School office in LH 528 to schedule your
practicum interview with practicum faculty. At that interview, your next steps will be
discussed for your progress into your placement.
2
BACHELOR OF SOCIAL WORK PROGRAM
Application for Admission
The following documents are necessary to complete the program application:
Application (incomplete applications will not be considered)
Personal Narrative
Two References (forms available at www.wichita.edu/BSWapplication)
Copy of transcript or Degree Works – unofficial (WSU students can get a copy from MyWSU Self Service. Go to Student Records,
then Academic Transcript.)
WSU Model (photo) Release Form
Ethical Agreement
Practicum Statement
Liability Insurance Notification
BSW Manual Acknowledgement
Computer Competency Statement
If you are also applying for the Undergraduate Certificate in Social Work and Addictions, please complete the page 10
(Please print or type) Date
Program Information
Are you a full-time or
part-time student?
Full time (12 hours or more)
Anticipated graduation date?
Part time (less than 12 hours)
Personal Information
Name
MyWSU ID#
Last First Middle
Other Last Name(s)
Preferred Name
Address
Street and number City State Zip Code
Telephone
Home Work Mobile
Email(s)
@shockers.wichita.edu
Other
3
Personal Narrative
Attach a personal narrative (TYPED, double-spaced, one to two pages in length) to support your application. It should address the
following:
Why do you seek a degree for a career in social work?
What notable qualities do you regard as your strengths for entry into social work?
What qualities might you regard as personal limitations for entry into social work?
What interests, motivations and experiences do you have that would establish suitability for the social work profession?
Address your academic background – describe in your own words any academic or transcript challenges that may affect you in the
program.
Are there any personal, physical, or emotional barriers that will make it challenging for you to participate in the social work
programs? If yes, please explain.
Are you receiving services through WSU Disability Services? If yes, would accommodations be needed in an agency setting?
To applicants for the Undergraduate Certificate in Social Work and Addiction (UCSWA), please also answer the following
questions in your narrative:
Why are you also interested in pursuing a specialized certificate in this arena?
Do you have any volunteer, paid employment, or personal experiences related to working with addiction issues?
How did you hear about the Undergraduate Certificate in Social Work and Addiction?
Demographic Information (optional)
Demographic information is optional and is for statistical purposes only. It will in no way affect the consideration of your application.
Date of birth: Gender: Male Female Veteran: Yes No
Race / Ethnicity:
Are you Hispanic or Latino? Yes No
Please select one or more of the following racial groups:
Asian American Indian or Alaskan Native Black or African American
White Native Hawaiian or other Pacific Islander
Pre-Program Requirements
Please check that you have met the following requirements for application to the BSW Program.
Cumulative GPA of 2.0 or higher. Current GPA:
Completion of at least 45 credit hours. Number of hours completed:
Course Requirement Completed (Grade C or better)
Semester Taken
Grade
ENGL 100 English Composition or 101 College English
ENGL 102 College English II
COMM 111 Public Speaking
MATH 111 College Algebra, 131 Contemporary Mathematics or 112 Precalculus
Mathematics
Course Requirement Completed or Enrolled in Currently
Semester Taken
Grade
BIOL 106 Human Organism or Human Biology equivalent Lab (Any Natural Science)
PSY 111 General Psychology
SOC 111 Introduction to Sociology
SCWK 201 Introduction to Social Work and Social Welfare or equivalent course from
another college with “C” or better
To Be Completed by the School of Social Work ONLY
BSW Orientation: In Person Online
Date:
4
Background Information
Have you ever been convicted of a felony or misdemeanor as an adult? Yes No
Has any governmental agency ever substantiated allegations made against you for physical, mental or emotional abuse or neglect,
sexual abuse, or exploitation of (1) a child, (2) a resident of an adult care home, medical care facility, psychiatric hospital or state
institution for the mentally retarded, or (3) an adult? Yes No
If you answered yes to either of the above, please attach an explanation.
Answering “yes” does not automatically disqualify you for admission to the BSW program or from the UCSWA. However, depending on
circumstances, it may affect your ability to be placed in a field practicum which is necessary to complete the BSW program or certificate
requirements. Please contact the BSW Program Director or UCSWA Program Coordinator if you have any questions.
I understand that prior convictions, diversions or pending charges may affect my ability to be placed in a field practicum which is
necessary to complete the BSW program or UCSWA. This means that while you may be admitted to the program, you may not be able
to complete the degree or certificate if there is something in your background that would prevent you from being placed in a field
practicum. Many agencies require background checks. Some criminal charges may affect your ability to be licensed in the State of
Kansas.
I certify that the information on this completed application form is accurate and complete.
Signature of applicant (Type name if submitting electronically.) Date
Application Packet
Return completed application form together with the personal narrative, two references and a copy of transcript to:
School of Social Work Questions? Call the School of Social Work office at (316) 978-7250
Wichita State University or contact:
528 Lindquist Hall Shaunna Millar, BSW Program Director
1845 Fairmount (316) 978-5853, shaunna.millar@wichita.edu
Wichita, KS 67260-0154 or
or submit electronically to socialwork@wichita.edu Deah Davis, UCSWA Coordinator
or by fax to (316) 978-3328 (316) 978-7269, deah.davis@wichita.edu
Application deadlines are December 1
st
and July 1
st
. Applications are reviewed
by committee after each deadline. Late applications will not be accepted.
Notice of Nondiscrimination: Wichita State University does not discriminate in its programs and activities on the basis of race, religion, color, national
origin, gender, age, sexual orientation, marital status, political affiliation, status as a veteran, genetic information or disability. The following person has
been designated to handle inquiries regarding nondiscrimination policies: Director, Office of Equal Employment Opportunity, Wichita State University,
1845 Fairmount, Wichita KS 67260-0205; telephone (316) 978-6791.
Revised 6/27/2017
5
Ethical Agreement
I, , certify that I have read and understand the NASW Code of Ethics and I will abide by this
code of ethics to the best of my ability. I aspire to learn more about social work’s values, knowledge and practice skills throughout my
student and professional years. I will seek professional growth through interaction with faculty, colleagues and other assigned tasks in
the Wichita State University School of Social Work program. I understand that failure to demonstrate Social Work Ethics in my time in
the BSW program may result in my removal from the program.
Signature of applicant (Type name if submitting electronically.) Date
Date
NOTE: The NASW Code of Ethics can be found on the NASW website at http://www.socialworkers.org/.
6
BSW Manual Acknowledgement
I, , certify that I have been advised to read the Wichita State University School of Social
Work BSW Manual, located at http://webs.wichita.edu/?u=socialwork&p=/bsw/bswstudentmanual/.
I agree to follow the expectations outlined in that manual throughout the course of my BSW program experience. If also admitted to the
Undergraduate Certificate in Social Work and Addiction certificate program, I understand I am expected to abide by these expectations
throughout the course of my certificate participate, as well.
Signature of applicant (Type name if submitting electronically.) Date
7
Computer Competency Statement
Students admitted to the School of Social Work are expected to demonstrate competency with the following computer skills:
1. Word Processing (WORD or Word Perfect preferred – not Microsoft Works) with the following formatting skills:
Setting font size and type
Setting margins
Setting line spacing
Creating headers and footers
Inserting tables
Italicizing
Inserting page numbers – in a header
Centering text; right and left justification
2. Sending and receiving email with attachments from Shocker email
3. Accessing the Internet
4. Students are expected to have familiarity with the following:
Presentation program (PowerPoint)
Spreadsheet (Excel)
Blackboard
Presentation software, such as PowerPoint or Prezi
Students not competent with the above computer skills must complete a computer workshop or class prior to entering the Social
Work BSW or UCSWA Program.
I, , have been informed of the expected computer competency for the Social Work program.
I understand that it is my responsibility to demonstrate competency in the stated skills. I understand that my grades may be
significantly affected by poor application of the above computer skills.
Signature of applicant (Type name if submitting electronically.) Date
8
Practicum Statement
I, , understand that I will be required to attend practicum orientation as part of the application
process for the practicum program. I also will be required to complete a practicum inventory, along with completion of a resume and
Senior Form. This must be completed during the fall semester of my junior year by December 1
st
.
Signature of applicant (Type name if submitting electronically.) Date
9
Liability Insurance Notification
I, , certify that it will be required for me to obtain Student Liability Insurance as part of my
practicum application process.
Signature of applicant (Type name if submitting electronically.) Date
NOTE: The NASW Social Work Student Professional Liability Insurance can be obtained by members of NASW. To apply for
membership online, go to www.socialworkers.org. Application forms for the NASW student liability insurance can be found at
http://www.naswassurance.org/malpractice/student-liability-individuals/ . There are other options for liability insurance, as well, through
private providers or your own insurance group. You are not required to purchase liability insurance through NASW.
10
BSW Certificate Program in Social Work and Addiction
Students interested in the BSW Certificate Program in Social Work and Addiction should also complete this section.
Yes, I want to apply for the BSW Certificate Program in Social Work and Addiction
No, I’m not interested in applying for the certificate program
Rank: Freshman Sophomore Junior Senior
Current WSU Student? Yes No, current college/university: _ _
I’ve already graduated with a degree in social work, in _ _ (year)
If you are not a current student, please attach transcripts from all universities attended.
Be sure to address the questions in your narrative, as stated on page 3 of this application packet.
11
Course Planning Worksheet
Student Name myWSU ID
Date Advisor Year
FALL SEMESTER
SPRING SEMESTER
SUMMER SEMESTER
Year
FALL SEMESTER
SPRING SEMESTER
SUMMER SEMESTER
Year
FALL SEMESTER
SPRING SEMESTER
SUMMER SEMESTER
Year
FALL SEMESTER
SPRING SEMESTER
SUMMER SEMESTER
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BSW App 6-27-2017

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Completed 16 February 2020

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