Employment Based Practicum (EBP) Application
BSW
DUE DATE: June 1st, 2016
Students are strongly encouraged to submit this application as soon as possible. If the EBP is not approved, the student will begin the regular practicum planning process, which is already underway.
Submit completed packet to:
PREFERRED OPTION- Scan and send by email to
OR
By mail to KUSSW ▪ Field Education ▪ 1545 Lilac Ln. ▪ Lawrence KS ▪ 66045
I.A.Statement of Understanding and Support
What is an Employment Based Practicum (EBP)?
Most students are placed in a regular practicum setting by the Field Education Office. However, a small number of students consider applying for an Employment Based Practicum (EBP). An EBP allows a student to use his or her current place of employment, but not the employment position, as the site for the field practicum.
The student’s practicum learning assignments must be different from her/his work responsibilities. This is often accomplished by assigning the student to a different unit, a different population of clients, opportunities to work with different staff, different agency documentation, or different community supports from the student’s regular employment responsibilities. The employing agency must be able to support a reduction in the student’s regular work activities so that the time required for field practicum can be added to the student’s weekly schedule.
Students may applyfor an EBP if ALL of the following criteria are met:
- The student is currently employed and has been employed a minimum of 6 months within a social service agency that meets the requirements necessary for field practicum as determined by the School of Social Welfare;
- The agency is able to provide educational opportunities that are clearly different from the student's employment responsibilities;
- The agency is supportive of the student's educational objectives which include:
- time needed to attend academic classes, full time students will be taking 3 academic courses in addition to their practicum;
- reduction in regular work responsibilities to support the reassignment of the student to different learning opportunities within the agency;
- reduction of employment hours and assignment of practicum hours to 16 per week and;
- completion of their required coursework.
- The agency is able to provide a qualified field instructor (BSW + 2 years post BSW experience) to supervise the student. The field instructor cannot be the student's employment supervisor. This means the field instructor cannot have managerial or supervisory responsibility for the student’s employment. The field instructor agrees to provide regular supervision meetings face to face with the student on a weekly basis for at least 1- 1 ½ hours throughout the practicum.
Student’s Responsibility to Facilitate the EBP Application Process
Before completing the EBP application, the student needs to carefully discuss with his/her employment supervisor or agency administrator if the above criteria, as well as the learning opportunities can be met within the student's employing agency. It is the student’s responsibility to ensure the integrity of this process. Open and clear communication between all parties is imperative. If the agency or the student is unable to maintain the standards required for a sound educational experience, the result may be a terminated EBP and the student will be required to complete a regular practicum arranged by the Field Education Office.
I understand the purpose and function of an EBP, and my signature shows my support for providing the above criteria. In addition, my signature below indicates that I have participated in discussions with the student for the purpose of the development of this practicum proposal. My signature attests to my full support of this proposal and commitment to providing the learning opportunities for our employee/KU student.
Student’s Signature: ______Date______
Agency Administrator’s Signature: ______Date______
Agency Administrator’s Title and Address/Location: ______
Employment Supervisor’s Signature: ______Date______
Employment Supervisor’s Title and Address/Location: ______
Proposed Field Instructor’s Signature: ______Date______
Proposed Field Instructor’s Title and Address/Location: ______
I. B. Letter from the employment supervisor and agency administrator on agency letterhead (in some agencies this will be the same person). (Inserted or attached by student)
I. C. Letter from the proposed field instructor. (Inserted or attached by student)
II.Employment Based Practicum (EBP) Application—BSW
Student Information
Student Name: Click here to enter text.
E-mail:Click here to enter text.
Employment Information
Employer Name:Click here to enter text.
Address:Click here to enter text.
Telephone:Click here to enter text.
Authorizing Agency Administrator Name, Title, Email, and Address/Location:
Click here to enter text.
Student’s Current Job Title:Click here to enter text.
Date of Hire:Click here to enter a date.
Length of time in this position:Click here to enter text.
Prior positions in Agency, if any:Click here to enter text.
Student’s Current Employment Supervisor Name and Title:
Click here to enter text.
Student’s Current Employment Supervisor Email Address:
Click here to enter text.
Address where job duties will be completed:
Click here to enter text.
Total hours you will be working in your job once practicum begins:
Click here to enter text.
Client Population you work withClick here to enter text.
Primary Job Responsibilities:Click here to enter text.
III. Current Job Description—(Inserted or attached by student)
IV.Proposal
The optimal learning experience for a student is in a traditional practicum. However, personal circumstances can warrant the need for a student to use their place of employment to fulfill his or her field practicum requirements. Please write a brief statement identifying your personal circumstances and describe why are you applying for an EBP?
Click here to enter text.
Proposed Field Instructor (FI):
FI Name, Credentials, Title and E-mail: Click here to enter text.
Is the FI an Agency Staff Member:Choose an item.
Is the FI new to KU Field Instruction:Choose an item.
Will the FI be off-site; works in a different building than you?
Choose an item.
FI Responsibilities Agreement Form: Choose an item.
FI Resume: Choose an item.
Total weekly hours scheduled for practicum:Click here to enter text.
Client Population for practicum:Click here to enter text.
Agency Data Form: Choose an item.
PracticumResponsibilities: The student should describe and summarize appropriate learning opportunities required by the school to meet the educational goals of the BSW practicum. Include a description of the learning activities that will be available to fulfill practicum requirements. It should be obvious to the application reviewer what specific assignments the student will be completing for field practicum. Please review the BSWLearning Contract available at the School of Social Welfare’s website to become familiar with the required learning activities.
Click here to enter text.
V.Calendar
It should include the hours:
- Student’s plan to work their job,
- Student’s plan to be in Practicum (and what they will be doing),
- Student’s plan to be in classes; include commuting time,
- Student’s plan to study and prep for classes, and
- Dedicated self-care.
Sunday / Monday / Tuesday / Wed / Thursday / Fri / Sat
VI.Field Instructor Responsibilities Agreement Form
The Field Instructor is the student's primary educational resource within the agency, and as such agrees to support the educational goals of the School of Social Welfare's field education program. The field instructor must be willing to assume the overall responsibility for the student's educational experiences in the agency. The time commitment required of a field instructor is approximately 4 hours/week (1/2 day).To qualify, the field instructor must have a MSW degree from an accredited school of social work and at least two years of post graduateexperience (or to supervise BSW students, the Field Instructor must have a BSW degree from an accredited school of social work and at least two years of postgraduate experience). Specific responsibilities include:
1.Prepare for and conduct regularly scheduled face to face weekly supervision conferences with the student. Conferences are 1-1 ½ hours weekly for 30 weeks. A minimum of 30 hours of field education supervision is expected.
2.A minimum of 50% of practicum hours must be spent in direct client practice (except for SWAAP students)
3.Collaborate with the student in identifying safety concerns that need to be considered in the agency and practice, and develop a safety plan with the student.
4.Abide by the NASW Code of Ethics in your relationships with clients, colleagues and students and include discussions about the Code of Ethics in the weekly field education supervision conferences with the student.
5.Actively collaborate with the student and Field Liaison in the development, implementation and ongoing use of the Learning Contract.
6.Coordinate any student learning experiences that are overseen by other staff members.
7.Provide the student with ongoing feedback on the student's performance, including evaluation of both process and content oriented records that are required by the School.
8.Support the student in gaining access to additional learning opportunities and resources in the agency and professional community that may be of interest to the student.
9.Maintain an ongoing evaluation of the student's progress (verbal and written), and complete written evaluations of the student as required by the School of Social Welfare.
10.Collaborate with the Field Liaison in the planning, review and evaluation of the student's performance; recommend a mid-year and final grade to the Field Liaison.
11.Inform the field liaison promptlyof any problem in the field placement and, when necessary, develop a detailed written plan of remedial action with the student and Field Liaison.
12.Participate in school-sponsored field education meetings, and when new to field instruction in the KU School of Social Welfare, attend the seminar for new field instructors in August.
13.Provide feedback to the Field Liaison and the Field Education office on the performance of the student’s responsibilities.
14.If not already on file in the Field Education office, complete a resume and submit to the Field Education Office.
15. Protect the confidentiality of student records as dictated by the Family Educational Rights and Privacy Act (FERPA) and not release or disclose records regarding the student (other than to University) without prior written consent of the student or where required by law.
For Employment Based Practicums (EBP’s):
16.Ensure the student fulfills designated practicum hours that aredistinctly different from the student’s employment responsibilities (different client populations, paperwork, skill set, staff, etc). * A minimum of 50% of practicum hours must be spent in direct client practice.
17.Thoroughly review the students EBP application, showing your agreement and support of CSWE/KU’s expectations for EBP’s.
18.Actively collaborate with the student's agency work supervisor.This collaboration is likely to include coordination of student hours/work load to ensure reduced work responsibilities as well as dedicated practicum hours, along with resolving tensions that a student might experience between work and practicum responsibilities.
The submission of these materials indicates you have reviewed and agree to provide a practicum setting which meets KU’s learning objectives for the level of student you requested, as well as your agreement to abide by the requirements for field instruction. (If the field instructor is not the person filling out this form, it is the agency’s responsibility to be sure the field instructor receives a copy).
______
Name/Credentials Title
______
Signature (Not required for electronic submission)Date
VII.Proposed Field Instructor Resume—(Inserted or attached by student )