Office of Practicum Education New Practicum Instructor Application

We are 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.

Practicum Instructors MUST have a Bachelor of Social Work or Master of Social Work degree, two years post degree social work experience, and be eligible for licensure in the State of Michigan. 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 licensure eligibility must provide a minimum of one-hour weekly supervision to assigned student(s).

Fields with asterisks (*) are required.

First name *

Last name *

Email *

Telephone Number *

Fax Number *

Agency Position/Title *

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 *

License Number *

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

Have you been a Practicum instructor before? *

If yes, what curricular year, when 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. *