Submitted by gsiegchrist on October 11, 2018 - 09:28 1 Start 2 Preview 3 Complete EBFI Agency Criteria To be considered as an Employment Based Field Internship (EBFI), the agency must be able to meet the following criteria: A total of 960 hours in field internship learning between the end of classes (mid-August) and the MSW student’s return to campus (end of May). The flexibility for the employee/M.S.W. student to attend 10 weeks of class instruction at Smith from June to mid-August. The opportunity for the employee/M.S.W. student to undertake a change in work focus and role (or a new position at the agency). New assignments which are designed to meet Smith’s defined learning objectives for the field internship. The assignments should include: a focus on educational needs 2 hours of supervision a week by an M.S.W. level clinical supervisor with a minimum of 2 years of experience post-M.S.W. the completion of 1 process recording a week by the M.S.W. student/employee, and the opportunity to engage in approximately 12-15 hours of direct practice each week with individuals, families, groups, and/or communities. It is also preferable that the M.S.W. student/employee be given the opportunity to participate in additional forums for learning (e.g., case conferences, staff meetings). To be considered, the employee/M.S.W. student must have completed the probationary period at their current agency by February 21. Please note: this form must be filled out jointly by the applicant and the agency Director of Training/Official Agency Representative. Deadlines: Five College Circle of Scholars: November 30 Non-Binding Early Decision: January 5 Regular Admission: February 21 Applicant Information First Name * Middle Initial Last Name * Home Phone Business Phone Mobile Phone Current Email Address * Agency Information Agency at which applicant currently works * Agency Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Agency Director of Training/Agency Representative Name * Phone Number * Email * Applicant's Current Supervisor Name * Phone Number * Email * Applicant's Length of Employment at Agency * Note: Applicant must have passed the probationary period at their current agency by February 21. Has this employee completed the agency probationary period? * Applicant's Current Job DescriptionBriefly describe the setting within which you work, including the field of practice, client population served (e.g., age, ethnicity, problems), and your current duties and responsibilities. longform Upload Job Description Microsoft Word or PDF formats only. Please do not use quotes in the document name. Maximum file size: 25 MB. If you need to submit a larger file, please email it to firstname.lastname@example.org.Files must be less than 25 MB.Allowed file types: pdf doc docx. Proposed New M.S.W. Supervisor for M.S.W. Applicant/Employee Name * Phone Number * Email * Year M.S.W. Degree Conferred * Upload CV/Resume Microsoft Word or PDF formats only. Please do not use quotes in the document name. Maximum file size: 25 MB. If you need to submit a larger file, please email it to email@example.com.Files must be less than 25 MB.Allowed file types: pdf doc docx. Briefly describe the plan for the M.S.W. student’s learning assignments, including client caseload size, groups, milieu work, etc. Indicate how the focus of the field learning assignment will be different from work they currently do at the agency as an employee. * Other comments, questions or concerns By my initials below, I (the applicant) acknowledge the following: I acknowledge that with the submission of this form, I am aware that the Smith College School for Social Work will be contacting my current employer. * I further acknowledge that this conversation with my agency does not represent an offer of admission. Admission decisions will be processed separately upon the review of all admission materials. Admission decisions will be sent with a letter affirming or denying approval of my agency as an EBFI) * By my initials I (the agency Director of Training/Official Agency Representative) confirm that this agency can meet the above criteria: * Questions? Please contact the Office of Admission at (413) 585-7960 or by email at firstname.lastname@example.org Next Steps: Once all admission application materials are received, the EBFI application will be separated from the MSW Admission Application Materials. The EBFI will be sent to the Field Work Department for review. The Agency Director of Training/Agency Representative should expect a call from the Field Work Department very soon after the materials are received. Admission materials will be reviewed by the Admission Office; the Admission and EBFI decisions will be made independently of each other. The EBFI decision will be forwarded to the Office of Admission. The MSW Applicant will be sent a decision packet which will include our admission decision and, if Smith is offering admission, an EBFI decision letter from the Field Work Department. If authorized by the MSW applicant/Employee, a copy of this packet will be sent to the Director of Training/Agency Representative. It is understood that the offer of an employment based internship is made in good faith and in consultation with your agency. If, for some reason, the agency is unable to move forward with an accepted internship plan the MSW applicant will be given the option of deferring their admission or may be offered a new internship assignment in a Smith-affiliated site.