Planning Form (MSW)

The purpose of this form is to compile pertinent information for planning and decision-making regarding the field placement. When completed, information in this form will be shared with potential field placement sites in preparation for the pre-placement interview. A copy will be retained in the School of Social Work.

Please note that although all attempts are made to secure an appropriate field placement for a student, the School of Social Work does not guarantee any student a particular field placement site. Authority for the assignment of field placement sites rests with the Field Education Coordinator. By signing this form, the student agrees that s/he/they will not unreasonably refuse a field placement site that the Field Education Coordinator has determined to be appropriate. In consultation with the student, refusal of an appropriate site may constitute a withdrawal from field placement. The student also agrees to the sharing of pertinent information with potential field placement agencies, in compliance with the Freedom of Information and Protection of Privacy Act.

Should you have any questions or concerns regarding this form, please contact the Field Education Coordinators, Jacky Coates: sw.field@ubc.ca and/or Tina Buttar: sowk.fieldeducation@ubc.ca.
I am requesting the following field placement to complete my Social Work Degree:*
- MSW Advanced SOWK 560
Contact Information
Name*
First Last
What pronouns do you use?
- He/Him/His
- She/Her/Hers
- They/Them/Theirs
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 1*
Phone 2
Email*
Language Proficiency (other than English)*
I hereby authorize the UBC School of Social Work to release information provided in the Field Placement request Form, Resume, and field placement application process to potential Field Placement Agencies and Field Instructors.*
- Yes, I consent.
- No, I do not consent.
Considerations for Field Planning
1. Describe how your previous experiences (employment, volunteer and field placement) contribute to this field placement request.*
2. Discuss the strengths and skills which you will bring to a field placement.*
3. Describe what knowledge and skills you hope to acquire during field placement.*
4. Describe the learning environment and the instructions/supervision styles in which you learn best.*
5. Identify your short term and long term professional goals.*
6. Do you have use of a vehicle for field placement?*
- Yes
- No
7. Will you be employed while in field placement?*
- Yes
- No
8. Are you willing to update any immunizations that may be required to partake in the field placement?*
- Yes
- No
9. Do you agree to abide by the Social Work Code of Ethics in your field placement?*
- Yes
- No
Please see the Code here: https://www.bcasw.org/about-bcasw/casw-code-of-ethics/
10. Are you aware that violations to the Code of Ethics can lead to termination of your field placement?*
- Yes
- No
11. Do you agree to follow the School of Social Work policies and procedures regarding field placement?*
- Yes
- No
Please see the Field Education Policy Manual here: https://socialwork.ubc.ca/wp-content/uploads/sites/32/2019/05/FieldEdPolicyManual_20190820.pdf
12. If you are interested in an out-of-town/rural placement, please fill in any ideas you have about this (i.e., specific organizations or agencies).
13. Do you wish to self-identify as an Indigenous student (First Nations, Métis, or Inuit)?
- Yes
- No
Preferred Service Groups
Please indicate your first, second and third choice for preferred service groups.
First Choice*
Second Choice*
Third Choice*
Do you have a particular preferred service group (not listed) that you would like to explore? If so, please explain.
Primary Interest for Social Work Practicum
Please indicate your first, second and third choice for preferred primary classification.
First Choice*
Second Choice*
Third Choice*
Do you have a particular area of interest (not listed) that you would like to explore? If so, please explain.
Placement Site Ideas
Please fill in your first, second and third choice for preferred placement sites, if any.
First Choice
Second Choice
Third Choice
UBC School of Social Work is committed to providing an equitable learning environment that promotes and supports academic achievement. If you have special circumstances like childcare or transportation concerns please let us know.

The process for confirming accommodations for academic or practicum due to a disability is undertaken through the Centre for Accessibility to formally confirm the accommodation request. Please visit the UBC Centre for Accessibility website for more information.

All students are advised to discuss their possible need for accommodation with the Field Education Coordinator.
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Planning Form (MSW)

Contact Information

Considerations for Field Planning

Preferred Service Groups

Primary Interest for Social Work Practicum

Placement Site Ideas