Office of Practicum Education New Practicum Instructor Application

The School of Social Work's Office of Practicum Eduation is always interested in forming relationships with new agencies and Practicum instructors. Practicum instructors are required to meet with students weekly for at least one hour to provide supervision. Practicum instructors may meet individually or as a group, depending on the nature of work performed. This meeting should be used to discuss and reflect on student concerns regarding client, agency, and Practicum placement issues. The Practicum instructor should ensure that the student is fulfilling the needed core competencies, including the verification of required clock hours.

Wayne State University School of Social Work Office of Practicum Education requires our Practicum Instructors to have a Master of Social Work degree and two years post degree social work experiences with a license (LLMSW or LMSW) in the State of Michigan. However, we will consider a Practicum Instructor with a Master of Social Work degree and four years post degree social work experience, in lieu of the license. Those who want to serve as task supervisor do not need such credentials and may provide daily supervision to student(s); however, a social work degree holder with or without a license must provide a minimum of one-hour weekly supervision to assigned students. All supervision arrangements are ultimately subject to the discretion of the Director of Practicum Education.

Fields with asterisks (*) are required.

Practicum Instructor Contact Information

First name *

Last name *

Email *

Telephone Number *

Fax Number

Agency Position/Title *

Credentials

Agency Contact Information

Agency Name *

Address line 1 *

Address line 2

City *

State/province/region *

Postal/zip code *

Country *

Please select degree type. Degree must be from a CSWE/CASWE accredited institution. Applicant must have a minimum of two years post degree experience *

Master of Social Work (MSW)

Master of Social Work (MSW) and Doctoral Degree (PhD)

Other Degree Type

Degree and Licensure

Master of Social Work (MSW) Degree with Years of Social Work Experience *

MSW Graduation Date *

Number of Years of Post Social Work Experience *

State or Province License Issued In (If applicable)

License Number (If applicable)

License Issued Date (If applicable)

License Expiration Date (If applicable)

Please upload a copy of State of Michigan License or Social Work Degree

Have you been a Practicum instructor with the Wayne State School of Social Work before? *

If yes, what curricular year (Bachelor of Social Work BSW, MSW Foundation, MSW Advanced Year), what year(s) and how many students did you supervise?

I have reviewed the requirements and responsibilities associated with being a Practicum instructor and agree to assume those responsibilities, if I am designated as a Practicum instructor. *