Office of Practicum Education Application for Agency Participation

We are always interested in forming relationships with new agencies. If you are part of a social work agency in the metro Detroit or surrounding area, and you would like to work with our social work students, please complete the Application for Agency Participation to be considered as a placement site. 

Fields with asterisks (*) are required.

Agency Information:

Agency Administrator:

Contact Person:

Does your agency require an affiliation agreement? *

Practicum Instructor(s):

Practicum Instructors MUST have a Bachelor of Social Work or Master of Social Work degree and be Licensed (LBSW or LMSW). Those who want to serve as task supervisor do not need such credentials and may provided daily supervision to student(s); however, a social work degree holder with a License must provide a minimum of one hour weekly supervision to assigned student(s)

Placement Classifications:

Select the Curricular Year(s) of Potential Interns:

Please Select All that Apply *

Agency Practice Area(s) :

Please check all that apply *

Populations Served:

Please check all that apply *

Agency Schedule for Student Practicum Placement:

Please provide the days in which a student can perform Practicum placement tasks at the agency. *
Can you accommodate students during evening and/or weekend hours? *

Agency Requirements:

TB Testing *
Background Check *
Finger Printing *
Drug Screen *

Financial Stipends:

Does the agency provide financial stipends? *


Please review expectations for each curricular level in the Office of Practicum Education Manual at

Please feel free to contact the Office of Practicum Education with any questions or concerns.
Phone: 313.577.4446