Fillable Fall2017 MSW Program Application (California State University, Fresno)

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Fall2017 MSW Program Application (California State University, Fresno)

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Applicant Number________________________
Fall 2017 MSW ADMISSIONS APPLICATION
IDENTIFYING AND PERSONAL INFORMATION | REQUIRED
Fresno State Student ID # (If Applicable)
Last Name
First Name
Middle Name
Maiden Name (if applicable)
Mailing Address (it should match your CSU Mentor University Application)
City
State
Zip Code
Cell Phone
Work Phone
Home Phone
Email - REQUIRED
Date of Birth
Place of Birth
Emergency Contact(s) Relationship To You Email
Cell Phone
Home Phone
Work Phone
PERSONAL DEMOGRAPHIC INFORMATION | VOLUNTARY INFORMATION | NOT REQUIRED
The Department of Social Work Education encourages persons with disabilities to enroll, and encourages the enrollment
of ethnic minority students. PLEASE FILL IN THE SECTIONS BELOW:
GENDER: DISABILITY STATUS:
ETHNICITY: PLEASE SPECIFY :
If you wish to further specify the ethnic background you primarily identify with, please do so in the space provided.
• All information is CONFIDENTIAL
• Access restricted to faculty and staff in the
Department of
Social Work Education at Fresno State
Please check the Program status for which you are applying:
FULL TIME (primarily taking daytime classes)
PART TIME OPTION (primarily taking evening classes)
Choose One 3 Year 4 Year
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
1
PERSONAL DEMOGRAPHIC INFORMATION | REQUIRED
A
RE YOU A RESIDENT OF CALIFORNIA? YES NO
If YES, please specify for how long:
If NO, please specify State and Nation:
If you are a citizen of a country other than the USA, please indicate the country:
All citizens of foreign countries whose native language is not English should be aware that proficiency in English is required for
admission to graduate standing. All foreign applicants must take the TOEFL examination prior to admission. This requirement does
not apply to bilingual residents of the United States.
IF YOUR NATIVE LANGUAGE IS OTHER THAN ENGLISH, PLEASE ANSWER THE QUESTIONS BELOW:
Have you taken the (TOEFL) Exam? Date Taken Scores
YES NO
ACADEMIC AND PROFESSIONAL REFERENCES | REQUIRED
YOU MUST SUBMIT THREE (ONLY 3) LETTERS OF REFERENCE WITH YOUR APPLICATION:
Letters of reference can provide useful perspectives on an applicant’s character, academic and/or professional abilities,
background, and potential for success in the graduate social work education and social work profession.
A VARIETY OF REFERENCES IS ENCOURAGED.
• A current or recent supervisor or employer in either paid or volunteer agency/organization.
• Classroom instructor, if currently in school or are a recent graduate (within the last 6 years).
• A supervisor of a field based experience: internship supervisor, field coordinator/field liaison.
• Family, friends, and social acquaintances are NOT suitable reference sources.
NAME & TITLE
ADDRESS
RELATIONSHIP
DIRECTIONS:
Please make sure you send the department’s Reference Form (The form is available under Graduate Materials on our
website) to the above named individual and that they sign the sealed envelope flap before they return it to you.
• PLEASE DO NOT HAVE YOUR REFERENCES SEND THE REFERENCE FORM DIRECTLY TO OUR OFFICE. WE WILL
NOT ACCEPT THEM. It is your responsibility to send and collect your reference letters sealed and signed in
order to include them in your application packet.
• The Department may, in some instances, seek additional information from employers, references, and other
sources pertaining to this application.
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
2
EDUCATIONAL INFORMATION | REQUIRED
PLEASE LIST ALL SCHOOLS YOU HAVE ATTENDED SINCE HIGH SCHOOL. List in chronological order (begin with the most
recent), including all community/junior college, university, vocational, or professional schools attended. List your
major/area of study (if applicable).
THE DEPARTMENT OF SOCIAL WORK EDUCATION MUST RECEIVE A COPY OF YOUR TRANSCRIPT(S) FROM EACH SCHOOL
LISTED BELOW OR YOUR APPLICATION WILL NOT BE REVIEWED!
(Unofficial transcripts are acceptable with this application. Please note that official transcripts will be required by the
University, as stated in the CSU Mentor Application).
SCHOOL ATTENDED, LOCATION (City &
State)
SPECIFY MAJOR /
DEGREE PROGRAM
FROM
MO/YR
TO
MO/YR
GPA
DEGREE RECIEVED
OR EXPECTED & DATE
If you have more schools to list please use our “Educational Supplemental Form” and attach it directly behind this form. (Find it
under Graduate Materials on our website. Scroll to the bottom.)
ALL APPLICANTS ARE REQUIRED TO TAKE THE GRE (GENERAL TEST) FOR ADMISSION TO GRADUATE STUDIES.
Where did you take the GRE Test?
Date Taken
Verbal Score
Quantitative Score
Writing Score
PREREQUISITES ARE REQUIRED FOR NON-SOCIAL WORK GRADUATES. (Social Work Students/Graduates can skip this)
• CAREFULLY READ & REVIEW our Prerequisite Website Page: http://bit.ly/2bhdXn5
I HAVE COMPLETED/AM CURRENTLY ENROLLED/WILL ENROLL IN THE FOLLOWING PREREQUISITE COURSES:
PREREQUISITES
COURSE
COLLEGE/UNIVERSITY
COURSE NUMBER & TITLE
(HIGHLIGHT ON YOUR TRANSCRIPTS)
SEMESTER/QUARTER &
YEAR COMPLETED
(OR TO BE COMPLETED)
GRADE
(If Applicable)
Data Analysis
Human
Development
Cultural Diversity
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
3
EMPLOYMENT EXPERIENCE | REQUIRED (If Applicable)
Document your time in paid employment for the last 10 years. DO NOT include any supervised field internship, practicum,
student teaching experience, or service learning course activities for which you received academic credit. If you have
had meaningful experience from service learning course or internship you may cite them in your personal statement.
Important: Provide specific details of your involvement in each activity giving weekly hours and month duration.
AGENCY OR FIRM
NAME & ADRESS
PAID HRS
PER WK
TOTAL
MONTHS
FROM-TO
(MO/DAY/YR)
POSITION HELD
(Describe Duties Below)
AGENCY OR FIRM
NAME & ADRESS
PAID HRS
PER WK
TOTAL
MONTHS
FROM-TO
(MO/DAY/YR)
POSITION HELD
(Describe Key Duties Below)
AGENCY OR FIRM
NAME & ADRESS
PAID HRS
PER WK
TOTAL
MONTHS
FROM-TO
(MO/DAY/YR)
POSITION HELD
(Describe Key Duties Below)
AGENCY OR FIRM
NAME & ADRESS
PAID HRS
PER WK
TOTAL
MONTHS
FROM-TO
(MO/DAY/YR)
POSITION HELD
(Describe Key Duties Below)
EMPLOYMENT EXPERIENCE
TOTAL
MONTHS
TOTALS
If you need to add more to this section please use our
“Employment Supplemental Form” and attach it directly behind
this form. (Find it under MSW materials on our website)
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
4
0
INSTRUCTIONS FOR STATEMENT OF PURPOSE
The statement must be typed, double-spaced, Times New Roman, 12 point font, with 1-inch margins and must not
exceed 5 pages in length (anything past the 5
th
page will not be considered). It should enable the MSW Admissions
Committee to make an informed decision about your potential for success in the Master of Social Work Program and
the Social Work Profession.
In preparation for your application and Statement of Purpose, we strongly recommend that you review the following
websites and use them as resources:
• National Association of Social Workers: www.naswdc.org
• NASW Code of Ethics: http://www.socialworkers.org/pubs/code/default.asp
• Department of Social Work Education Webpage: http://www.fresnostate.edu/chhs/social-work/
• Council on Social Work Education: http://www.cswe.org/
YOUR “STATEMENT OF PURPOSE” MUST ADDRESS EACH OF THE AREAS LISTED
BELOW IN ORDER:
1. D
iscuss your goals for wanting to become a professional social worker.
2. D
iscuss your understanding of the social work profession.
3. Discuss the current challenges in society that social work can address. How do you participate in addressing those
challenges?
4. D
escribe your understanding of the values of social work profession as applied to professional practice.
5. Discuss what life and work adjustments you will have to make in order to manage your graduate educational
experience (2-3 days of internship and classes)?
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
5
APPLICATION CHECKLIST | PLEASE SIGN | REQUIRED
I HAVE ENCLOSED THE FOLLOWING ITEMS IN MY DEPARTMENT APPLICATION PACKET:
(Please put all paperwork in the order as shown below)
APP
LICATION TO THE MSW PROGRAM IN THE DEPARTMENT OF SOCIAL WORK
STATEMENT OF PURPOSE
3 COMPLETED REFERENCE FORMS
• Reference forms are in sealed envelopes. The reference has signed his/her name across the sealed flap.
I HAVE COMPLETED THE UNIVERSITY APPLICATION FOR ADMISSION (AT WWW.CSUMENTOR.EDU)
• I have paid the required fee.
• A copy of my confirmation/receipt is included
OR
I AM ALREADY ENROLLED IN ANOTHER POST BAC/GRADUATE PROGRAM (which means upon acceptance I will
file a change of degree objective)
GRE SCORES (A copy of my official scores is included).
TRAN
SCRIPTS FROM EACH COLLEGE ATTENDED ARE INCLUDED (Unofficial transcripts are acceptable).
I UN
DERSTAND THE FOLLOWING: INITIAL BOXES
Once I have declared my status, I will not be permitted to change my status (full-time/part-time) without
permission of the Graduate Program Coordinator and then only for serious and compelling reasons.
I understand
that if accepted into the MSW Program, two years (1000 hours) of internship are required.
I understand that if accepted into the MSW Program, I will be required to spend 16-21 hours a week at my
internship during regular work hours 8:00am-5:00pm, Monday through Friday. I may also be required to
commute within the Central San Joaquin Valley.
I understand that I will be notified by mail of the Admission Committee’s decision by the middle of May.
The letter will be sent to the address listed on my university application unless I have notified the MSW
Program, in writing, of a change in my address.
SIGNATURE: DATE:
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
6
I understand that if accepted into the MSW Program, I will be required to enroll in courses that are offered
in the morning, afternoon, and evening. I understand that I am not guaranteed enrollment in a course
during my preferred time.
(DSWE) MSW ADMISSIONS APPLICATION CHECKLIST | REQUIRED
Pl
ease fill in your NAME, REFERENCES, and SCHOOLS. Staff will use this form to check off all required items.
Name:
MSW APPLICATION
STATEMENT OF PURPOSE - This statement should be 1000 words (5 pages, Times New Roman, 12-font) in length
and attached to the admissions application.
LIST NAMES OF YOUR THREE REFERENCES BELOW - Reference forms MUST be included in the application packet
and each reference must be in a sealed envelope with signature across the sealed flap.
1.
2.
3.
CSU MENTOR APPLICATION PROOF/RECIEPT
GRE SCORES PROOF PRINT OUT
LIS
T ALL SCHOOLS ATTENDED (AFTER GRADUATING HIGH SCHOOL) Check off if transcript is enclosed.
1.
2.
3.
4.
5.
6.
DATE RECEIVED: REVIEWED BY:
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
7
INTAKE RECEIPT | FOR OFFICE USE ONLY
Please fill in your name and student ID# only.
NAME: STUDENT ID #
(
OFFICE USE ONLY) APPLICATION FOR ADMISSION TO THE MSW PROGRAM AT FRESNO STATE IS:
C
OMPLETE
I
NCOMPLETE AND MISSING THE FOLLOWING:
MSW APPLICATION
STATEMENT OF PURPOSE
REFERENCES – MISSING (#)
CSU MENTOR APPLICATION PROOF/RECIEPT
GRE SCORES (PROOF PRINT OUT)
TRANSCRIPTS – MISSING (#)
NOTES:
You must resubmit your application packet with the missing documents noted in the above checklist by January 31, 2017.
Application to the University must also be completed by this date.
P
lease address questions to the Graduate Admissions Secretary Azucena Rodriguez at 559.278.7076
N
OTIFICATION LETTERS WILL BE MAILED OUT IN EARLY MAY. Please do not call the office until after May 26, 2017 to
inquire about your status.
DATE RECEIVED: RECEIVED BY:
(Please keep for your records)
Department of Social Work Education | Fresno State, 5310 North Campus Drive, M/S PH102, Fresno, CA. 93740 | 559.278.3992
8
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Fall2017 MSW Program Application (California State University, Fresno)

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Completed 16 July 2020

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