Letter of Intent Form - New York

School of Social Welfare
Field Education Office
Richardson Hall
135 Western Avenue, Albany, NY 12222
PH: 518-442-5321 FX: 518-442-5380
www.albany.edu
LETTER OF INTENT form
- 2
nd
Field Placement
INSTRUCTIONS: Please complete and return this form to the Field Office by
Monday, February 24, 2014.
NAME: __________________________________
PHONE NUMBER: __________________ EMAIL:________________________
Placement Process OPTION:
I have reviewed the
SSW Student Guide to 2
nd
Field Placement
and the
Required
Reading for 2
nd
Field Placement
”.
I’ve chosen the following option for my 2
nd
field placement process:
I’ll locate my own placement within guidelines provided
I request placement by the Field Office (
I have attached a completed
application for 2
nd
Field Placement AND one copy of an updated resume that
includes my 1
st
field placement
)
What Advanced Concentration have you selected for your MSW Degree? (check ONE)
____CLINICAL PRACTICE ____MACRO PRACTICE
I am aware of the SSW Standards for Social Work Education and to adhere to the standards. I
understand that information about my academic and professional experiences will be shared with the
field placement agency. If I request to have the Field Office find my placement, I will accept the field
placement assigned. I am aware that many agencies require criminal background checks, child abuse
registry clearance and/or medical clearance documentation (i.e. drug testing, TB and Hepatitis-B
screens) prior to students being accepted in placements. Declining an agency’s request for a criminal
background check or health screening is likely to limit my placement options or lead to my not being
placed. I have read the 2
nd
Field Placement Required Field Reading and abide by the terms.
____________________________________ ___________________________
Student’s Signature Date
Page 1/1
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