Place of Employment Agency Placement Plan Questionnaire

Policy, Process, Criteria, and Application
For Practicum Placement at Place of Employment
(Work Site Placement)

Place of Employment Agency Placement Plan Questionnaire 

This section of the application for practicum placement at a place of employment is to be completed by the Agency Contact or Proposed Practicum Instructor. 

Policy, Process, and Criteria for Practicum Placement at a Place of Employement (Work Site Placement) can be found in the Practicum Education Manual at https://socialwork.wayne.edu/practicum/manual

Fields with asterisks (*) are required.

Does the agency provide services in several sites? *

Where will the student be assigned to do the practicum placement?

Will the assignments be different from the student’s job responsibilities? *

The practicum instructor should be one who does not present a conflict of interest or the appearance of a conflict of interest such as being a friend or a colleague of the student. An instance where the student is the executive director of the agency or is in a supervisory relationship with staff presents a conflict of interest.

Has this person previously supervised the student? *
Does this person have a BSW or MSW degree? *
Is the proposed practicum instructor an approved practicum instructor for WSU *

Address of proposed practicum instructor (if different from that given for agency)

Is the Agency an approved partner with Wayne State University School of Social Work? *

If not, an Application for Agency Participation is required before the application for a Place of Employment application will be considered. Please visit https://socialwork.wayne.edu/practicum to complete the application.

THE AGENCY AGREES TO PROVIDE THE APPROPRIATE PRACTICUM EDUCATION EXPERIENCE FOR THE STUDENT WHO IS A PRESENT EMPLOYEE, IF THE SCHOOL APPROVES PLACEMENT IN THE AGENCY.