Field Instructor Application

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First Name *

Last Name *

Title/Position *

Work Phone *

Email *

Name of Agency *

Site Address *

Name of Program *

Type of facility, population served and services offered: *

Years in your current position *

Years of social work experience *

Years of supervisory experience *

Degree(s) received *

College/University *

Date graduated *

License and/or certificate(s) received (Type and State) *

Please describe the generalist practice and assignments that you will provide to help the student(s) to become competent for beginning level social work practice *

Before sending in this application:

Please review the Ramapo College Fieldwork Manual at the program web site: http://ww2.ramapo.edu/sshs/social/fieldinstruct.aspx

Your completion of this application affirms your intention to provide supervision for the social work student placed at your agency including:

attend field instructor orientation or training where applicable
select appropriate assignments congruent with the specific course
where applicable assist the student in developing an educational contract
Provide on-going supervision throughout the placement (minimal one hour per week for students in Theory and Practice of Social Work I, II and III
Provide ongoing evaluation of student throughout the placement and complete end of semester evaluation instrument
Notify the Faculty Field Liaison of any problems or questions as soon as they become evident.

Any other information you would like to add

Please send a copy of your resume to
Suzanne Badawi
Director of Field Education
Social Work Program
Ramapo College of New Jersey
505 Ramapo Valley Rd
Mahwah, NJ 07430
or to sbadawi@ramapo.edu
fax (201) 684-7257 201-684-7132

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