Baccalaureate of Social Work Program (BSW)

Application Forms

2014-2015 Academic Year

Socialwork.iu.edu

Making an impact on baccalaureate social work education since 1975.

APPLICATION MATERIALSCHECKLIST

Please check off each item as you complete it and fill in the blanks with the appropriate information requested. Application to the BSW program is a self-managed process and it is your responsibility to see that all of the materials listed below are sent together in the same envelope. Your signature on this checklist acknowledges your understanding that if all parts of the application are not complete or included, your application may not be processed.

Once you have completed this checklist, please submit it along with the rest of the application.

/ Checklist with requested materials attached
/ Application Form
/ Self-Disclosure Statement Regarding Arrests or Convictions of a Sex Offense
/ Personal Narrative
/ Value Statement
/ Petition for Exceptional Consideration [if applicable]

Three (3) Letters of Recommendation [See specifications under “Assembling your application] Names of Referees:

/ 1) / ______
/ 2) / ______
/ 3) / ______

An Unofficial Transcript from EACH COLLEGE OR UNIVERSITY EVER ATTENDED INCLUDING ALLCURRENT TRANSCRIPTS (Transfer students admitted to the BSW Program must submit an official transcript from each college or university ever attended on or before the date of the BSW Program Orientation.)

List below University names:

/ 1) / ______
/ 2) / ______
/ 3) / ______
/ 4) / ______

______

Name (print) Signature Date

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INDIANA UNIVERSITYSCHOOL OF SOCIAL WORK

Application Form for Admission to BSW Program

DATE:______

UNIVERSITY ID NUMBER______

IU CAMPUS OR COLLEGE/UNIVERSITY YOU NOW ATTEND:______

Indianapolis Campus
IU School of Social Work BSW Admissions
902 West New York Street ES 4134B
Indianapolis, IN 46202-5156 / Bloomington
IU School of Social Work
BSW Admissions
1127 E. Atwater Avenue
Bloomington, IN 47401 / Richmond Campus
IU School of Social Work
BSW Admissions
2325 Chester Boulevard TomRaper Hall, #150 Richmond, IN 47374-1289
Gary Campus
IU School of Social Work BSW Admissions
3400 Broadway MP 3186
Gary, Indiana 46408-1197 / South Bend Campus
IU School of Social Work
BSW Admissions 1700 Mishawaka Ave.
Northside Hall, Rm. 418
South Bend, Indiana 46634-7111

PLEASE TYPE OR PRINT ALL ITEMS

1.Name: ______

Last FirstMiddle/Initial

2.E-mail Address (preferably IU address if applicable) ______

3.In order to identify transcripts and other supporting documents, please list other name(s) by which you are

known: ______

5.Current Address: ______

Street City State Zip

______

AM Phone Number PM Phone Number

6.Permanent address where application correspondence can be mailed (if different from above):

______

Street City State Zip Phone #

7.Emergency contact ______Phone number ______

8a. Birth date: ______8b. Gender: Male Female

9.Racial/Ethnic Data: (check correct box or boxes)
African-AmericanNative AmericanEuro-American
Chicano/MexicanAsian AmericanPuerto Rican

Other (please specify)______

10.Number of credits completed to date: ______

11.IU campus you are planning to attend if admitted: (check correct box)

Indianapolis Bloomington Richmond GarySouth Bend

12.Credit hours you are planning to take per semester: ______

Credit hours you plan to take per summer session: ______

What year do you intend to graduate?______

13.Please list all employment in chronological order starting with the most recent. Please be specific in describing the positions held, including part-time. If more space is needed, use a separate sheet and attach.

A.______

B.______

C.______

D.______

14.Please list significant volunteer experiences and/ or leadership positions in chronological order starting with the most recent. Please be specific in describing your role(s). If more space is needed, attach separate sheet.

A.______

B.______

C.______

D.______

15.List all social work courses you have completed and/or in which you are currently enrolled:

COMPLETED: / CURRENTLY ENROLLED:
______/ ______
______/ ______
______/ ______
______/ ______

16.Please tell us how you first learned of the IU School of Social Work BSW program.

______

______

17.Please refer to the enclosed sheets which provide you with a guide for preparing your Personal Narrative and Values Statement. Your application is not complete without all the required documentation including the Self Disclosure Statement regarding arrest or convictions on a sex offense and the reference letters.

______

Name (print) Signature Date

The applicant is responsible for submitting ALL reference forms, transcripts and other documents necessary for Admissions review.

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INDIANA UNIVERSITY SCHOOL OF SOCIAL WORK
BSW APPLICATION
SELF-DISCLOSURE STATEMENT
Regarding Arrests, Convictions on Offense, Felony, Misdemeanor, or Serious Traffic Violation

This form must be completed and included by EVERY applicant.

Have you ever been arrested for a sex offense against a child or children?

Yes No
If yes, when and where? ______

______

Were you convicted on these charges? Yes No

If yes, do you wish to appeal the School of Social Work’s Policy on Sex Offenders as outlined on page 20 of the BSW Student Handbook? Yes No

Comments______

2. Have you ever been charged or convicted of a felony, misdemeanor, or serious traffic violation such as reckless driving or driving while intoxicated that has not been expunged by a court?”

Yes No

Comments______

  1. Are you or have you ever been the subject of any disciplinary proceedings by any professional organization? Yes No

Comments______

  1. Do you have any currently pending criminal charges or disciplinary proceedings against you?

Yes No

Comments______

I understand that failure to disclose criminal background or professional disciplinary actions is grounds for dismissal from the BSW Program. Further, I understand that my criminal background or professional disciplinary history may render me ineligiblefor malpractice insurance and field placement.

______

Name (print) Signature Date

INDIANA UNIVERSITY SCHOOL OF SOCIAL WORKBSW APPLICATIONPERSONAL NARRAIVECOVER SHEET

Prepare a personal narrative, not to exceed ten (10) typed pages in length. In some detail and in your own style, respond to the items listed below. This Personal Narrative is a critical part of your application folder. Consider it your opportunity to communicate with the BSW Admissions Committee about yourself. Review your statement carefully to be certain it will give the committee members a clear picture of your interest and suitability for professional social work. Please utilize APA style to format the paper and cite sources, particularly in discussing your selected current issue. For APA guidelines, see

  1. Discuss and analyze two significant events in your growth and development that lead to your interest in Social Work. The Committee is most interested in what you learned from these events and how these lessons brought you to Social Work.
  1. What is your definition of a social worker? Elaborate on why you want to join this profession.
  1. Social Work is concerned with advocating for oppressed populations and populations at risk. Below are scenarios that describe experiences of individuals from populations at risk. You will write on three separate scenarios. Select one scenario from category 1, one scenario from category 2, and one scenario from category 3. Respond to the questions that appear below each scenario you selected.
  2. Category 1 Option a: Mary and Jill legally married four years ago. They decided to have a child. Mary became pregnant using an anonymous sperm donor and IVF (Invetro fertilization). Upon birth of the child Mary Smith and Jill FitzWilliams sought to have both of their names recorded on the birth certificate as the child’s parents. The hospital refused noting the couple planned to call the healthy 6 pound 3 ounce baby boy William Smith and an additional surname on the birth certificate would create confusion for the child.
  3. Articulate the individual and societal issues implicated by this scenario.
  4. Discuss personal morals and values that influence your identification of issues in this scenario.
  5. Identify individual (micro) solutions or action steps you could propose and support to resolve these issues.
  6. Identify societal (macro) solutions and actions steps you could propose and support to resolve these issues.
  1. Category 1 Option b: Thomas and Jason have been in a committed relationship for 20 years. They are not legally married as marriage between same sex individuals is illegal in their state. They have chosen not to travel to another state where it is legal thinking it their duty to help change the laws where they live. Yesterday, Thomas had a terrible car accident and is currently in a local hospital. A decision needs to be made regarding treatment. Jason who knows Thomas better than any other person on the planet is neither consulted nor allowed to visit. Thomas’ sister who has not seen Thomas for 18 years which was when she learned that he is gay is consulted as she is the next known legal kin.
  2. Articulate the individual and societal issues implicated by this scenario.
  3. Discuss personal morals and values that influence your identification of issues in this scenario.
  4. Identify individual solutions or action steps you would propose and support to resolve these issues.
  5. Identify societal solutions and actions steps you would propose and support to resolve these issues.
  1. Category 2 Option a: Tammyis a 12 year old girl who associates with a group of older men and possibly may be taking drugs. She has a reputation in school of a sexually promiscuous girl.She disclosed having had intercourse with 5 adults. Two of the adults received warnings from the police to stay away from Tammy after admitting to the Police that they had intercourse with Tammy. Tammy frequently fails to come home, is often picked-up at school by a non-family member adult male, and is disruptive in school. A school case conference was held to determine whether Tammy should be reported to Child Protection services or probation. It was agreed by all at the conference that Tammy was in need of help. However, the principal argued against contacting child protection as this was not a sexual abuse issue. He thought Tammy had been “100% consensual in every incident” and some of the older men were high school students known to be good kids. He saw the issue as juvenile delinquency with an acting out child.
  2. Articulate the individual and societal issues implicated by this scenario.
  3. Discuss personal morals and values that influence your identification of issues in this scenario.
  4. Identify individual solutions or action steps you would propose and support to resolve these issues.
  5. Identify societal solutions and actions steps you would propose and support to resolve these issues.
  1. Category 2 Option b: Lisa is a 21 year old college student. She confided in you that one of her professors, Jon Doe has been putting pressure on her for a date. She feels uncomfortable about the pressure. She tells you, “I dated one of my professors last year. He was a lot of fun and I got a great grade in the class. But, I am not into Professor Doe.” You talk to your advisor and tell her about Lisa’s discomfort. The advisor says, “Professor Doe wouldn’t date a student. It is against University policy. Besides, he is married and has two kids.”
  2. Articulate the individual and societal issues implicated by this scenario.
  3. Discuss personal morals and values that influence your identification of issues in this scenario.
  4. Identify individual solutions or action steps you would propose and support to resolve these issues.
  5. Identify societal solutions and actions steps you would propose and support to resolve these issues.
  1. Category 3 Option a: You and two of your friends are standing at a busy fast food counter waiting to order. The clerk looks past a young man dressed in baggy pants and a hoodie sweatshirt and invites an elderly Caucasian woman to order. The woman points to the young man saying he was here first. The clerk snaps, “I’ll get to him when it is his turn.” She maintains steady eye contact with the woman not looking at the young man at all. After a pause, the woman shrugs her shoulders, sighs, steps forward and orders. The young man turns and walks out of the restaurant. When you get to your table with your food you discuss the situation just observed. One friend says, “That clerk is racist.” Your other friend says, “I think the kid over reacted.”
  2. Articulate the individual and societal issues implicated by this scenario.
  3. Discuss personal morals and values that influence your identification of issues in this scenario.
  4. Identify individual solutions or action steps you would propose and support to resolve these issues.
  5. Identify societal solutions and actions steps you would propose and support to resolve these issues.
  1. Category 3 Option b: During a class discussion one of your classmates provides an insightful analysis about a current United States and China diplomatic challenge. In response to your classmates comment the instructor says, “What an insightful comment for an Asian-American woman. Is your family from China? I mean, that was really good.” At break you overhear your classmate expressing frustration at being insulted.
  2. Articulate the individual and societal issues implicated by this scenario.
  3. Discuss personal morals and values that influence your identification of issues in this scenario.
  4. Identify individual solutions or action steps you would propose and support to resolve these issues.
  5. Identify societal solutions and actions steps you would propose and support to resolve these issues.
  1. There are many social issues that impact social work practitioners and the oppressed populations with whom we work. Though many issues and populations could be appropriate for this portion of the application, we provide a list of selected topical areas for your convenience. Select one issue whether from the list provided or from one of your areas of interest. Describe and analyze the current state of the issue.

a. Access and affordability of health care

b.Child welfare

c.Marriage equality and protections for the GLBTQ community

d.Impact of globalization on local communities

e.Veterans services

f.Immigration

g.Income inequality

h.Criminal justice system and racial disparity

i.Social security

j.Human Trafficking

k.Other social issue and oppressed population of interest to you.

  1. Please, include any additional information that you think is relevant to your application to the BSW Program.

______

Please sign, date, and attach this cover sheet to your narrative.

______

Name (print) Signature Date

INDIANA UNIVERSITY SCHOOL OF SOCIAL WORK

BSW APPLICATION

VALUE STATEMENT

COVER SHEET

The National Association of Social Workers (NASW) Code of Ethics states, The mission of the social work profession is rooted in a set of core values. These core values, embraced by social workers throughout the profession’s history, are the foundation of social work’s unique purpose and perspective:

  • service
  • social justice
  • dignity and worth of the person
  • importance of human relationship
  • integrity
  • competence

After reviewing the NASW Code of Ethics ( select one of the above mentioned values, define the value, explain what that value means to you, and articulate how that value shapes your perception of social work practice.

Please type your statement on a separate sheet of paper. Sign below and attach this cover sheet to your statement.

I have selected: ______

I understand that if accepted into the BSW program, I am expected to adhere to the values, ethics, and standards of the social work profession.

______

Name (print) Signature Date

INDIANA UNIVERSITY SCHOOL OF SOCIAL WORK

BSW APPLICATION

PETITION FOR EXCEPTIONAL CONSIDERATION

An applicant who believes that her or his individual circumstance warrants consideration for a waiver of the minimum admissions requirement of a 2.5 GPA to be considered for admission review must petition the BSW Admissions Committee for a waiver.

The petition should be submitted by the applicant in the form of a written statement entitled “Petition for Exceptional Consideration” and be attached to this completed cover sheet. The petition must include a statement indicating:

1). How the minimum admission requirement of a 2.5 GPA does not provide the applicant a fair and adequate opportunity to present herself or himself in a favorable light;

2). How the applicant has indeed demonstrated a capacity for successful achievement in a rigorous BSW program;

3). How, if granted admission to the BSW program, the applicant plans to address potential obstacles to successfully complete the program; and,

4). The applicant should attest to the accuracy of all information provided in the petition, date and sign this cover sheet.

The petition must be submitted with the application packet.

My signature below attests that all information provided in my Petition for Exceptional Consideration is true and accurate.

______

Name (print) Signature Date

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INDIANA UNIVERSITY SCHOOL OF SOCIAL WORK

BACHELOR OF SOCIAL WORK (BSW)

Request for Reference

Request for Reference (Page 1 out of 2)

DEAR REFEREE, ______,

(Applicant, please print the name of the person completing this recommendation form.)

You have been selected to complete the following recommendation form for ______.

(Applicant, please print your name.)

Application to the BSW program, Indiana University School of Social Work, is a self-managed process; therefore, the applicant is responsible for collecting and submitting all reference letters. This process insures that the applicant knows the application is complete when submitted. Your candid assessment of the applicant will greatly assist the Admissions Committee in determining whether the candidate should be admitted to the baccalaureate social work program.

When finished, please seal bothpages of the reference form and the supporting letter, if applicable, in a business size envelope, seal the envelope, and sign across the seal. Please return the completed reference to the student in the signed and sealed envelope. The student will then submit your reference in the signed and sealed envelope.

(Applicant, please fill in your address here)

______

StreetCityStateZip

Please send both forms as directed above.