Mentoring Request

Mentoring Request

COMPLETE ONLINE AND EMAIL TO AS AN ATTACHMENT. ALTERNATIVELY PRINT AND MAIL COMPLETED FORM TO: BCASW,402 - 1755 WEST BROADWAY, VANCOUVER BC V6J 4S5

Applicant Information

Full Name:
First / Last
City/Town: / Contact me by: / E-mail Address (H): / Phone (H) : / ()
E-mail Address (Wk): / Phone
(Wk): / ()
I am a student / School: / Expected Graduation Date:
I am employed / Employer: / Job Title:
I am not employed
DEGREES OBTAINED: / BSW / MSW / DSW/PhD / YEAR GRADUATED: / Check Here if RSW
Choose one of the following:
I require brief mentoring assistance with:
Practice Concerns / Ethical Questions / Skill Development
Job/Workplace Concerns / Other (please indicate)
I require brief mentoring assistance with:
Resume Writing / Job Search Strategies / Career Consultation
I require longer term mentoring assistance withmaking the transitionfrom school to practice
I am completing my Social Work degree/I am a recent graduate
My interest are in these areas of practice:
Adoption / Addictions / Workplace/Organizational / Justice
Gerontology / Child Welfare / Medical/Health / Children/Youth
Mental Health / EAP / Disability/Rehabilitation / Rural Social Work
Community Living / Aboriginal / Coaching / Immigration
Palliative Care / Social Policy / Training/Consultation / Group Work
Community Development / Education / Employment Counselling / Private Practice
Advocacy/Social Action / Cross Cultural / Conflict Resolution / Clinical Practice
Violence/Abuse / Research / Other (Please indicate)
Please add any additional information that will assist us in finding a good match for your needs:

Agreement

In requesting mentoring services, I agree to the following: The BC Association of Social Workers and the BCASW Mentoring program accept no liability whatsoever arising from the conduct of, or assistance provided by, a mentor. Mentors are made available in good faith to support the professional development of those receiving the service.
I agree to maintain my BCASW membership in good standing for the duration of the mentoring.
Name/Signature: / Date: