UMB School of Social Work

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Application for Field Liaison Appointment

Name «

Address «

City «

State «

ZIP Code «

Phone Number «

Year of Liaison Appointment «

Assistantships are offered for two semesters minimum

Are You Applying For A Full-time Liaison or a Half-time Liaison «

Full-Time (15 - 18 students per year)

Half-Time (7 - 9 students per year)

Preparation for Teaching

SOWK 835 (Grade & Semester Taken) «

Teaching Practicum SOWK 837 (Grade & Semester Taken «

Faculty Member (Name & Course Taught)

SOWK 822 (Grade & Semester Taken) «

Previous Teaching Experience

How Many Years of Practice Experience Have You Had? Please Describe «

Are You Licensed in Maryland? (If so, which level?) «

Have You Been a Field Instructor? If So, Please Describe «

Are There Times or Days Where You Would NOT Be Able To Make Liaison Visits? «

SSW Field Placements are M+W; T+Th; T, W, +TH

Are There Geographic Areas Where You Would NOT Be Able to Make Liaison Visits?

Western Maryland

DC & Northern Virginia

Southern Maryland

Northern Maryland, Southern Pennsylvania, & Delaware

Eastern Shore

Are There Special Talents, Interests, or Abilities You Bring To The Field Liaison Experience?

Are There Special Considerations We Should Know About?

Names and Contact Information of Three References «

At Least One Must Be From A Practice Setting

Attach A Copy Of Your Vita

Or send it to Barbara Brown, Director of Field Instruction - UMB School of Social Work - 525 West Redwood St. - Baltimore, MD 21201

Fields marked with "«" are required.

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