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Dear Valued Field Placement Agency:
We appreciate your time and dedication to be a part of our field program. This agency questionnaire will provide information about your agency to be matched with student's interests in the Social Work Field Program. Please complete all questions to the best of your ability. If you should have any questions please contact the UWRF Social Work Field Placement coordinator.
Profit Nonprofit Public Welfare Education/Government Tribal/Reservation
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Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee LaCrosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Saint Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood
Aitkin Anoka Becker Beltrami Benton Big Stone Blue Earth Brown Carlton Carver Cass Chippewa Chisago Clay Clearwater Cook Cottonwood Crow Wing Dakota Dodge Douglas Faribault Fillmore Freeborn Goodhue Grant Hennepin Houston Hubbard Isanti Itasca Jackson Kanabec Kandiyohi Kittson Koochiching Lac qui Parle Lake Lake of the Woods Le Sueur Lincoln Lyon Mahnomen Marshall Martin McLeod Meeker Mille Lacs Morrison Mower Murray Nicollet Nobles Norman Olmsted Otter Tail Pennington Pine Pipestone Polk Pope Ramsey Red Lake Redwood Renville Rice Rock Roseau Scott Sherburne Sibley St. Louis Stearns Steele Stevens Swift Todd Traverse Wabasha Wadena Waseca Washington Watonwan Wilkin Winona Wright Yellow Medicine
*Please check 'Same as Above' if you are the Contact Person listed above, or fill out the fields below.
Same as Above
Person Completing Form (You):
This information will allow students to search our database for agencies they are interested in based on the following categories and details.
*Top categories which best describe your primary agency service (check all that apply):
Domestic Violence or Crisis Intervention
Mental Health or Community Mental Health
Public Assistance/Public Welfare
School Social Work
Primary Target Populations (check all that apply):
Intern Activities (check all that apply):
Client Treatment Planning
Client Outcome Evaluation
Advisory Boards, Tasks Group, Planning Mtg
Emergency Assistance (i.e. food shelf, housing)
Public Policy Activities
Client Socialization Activities
Education (i.e. parenting, health)
Program Evaluation/Quality Assurance
Client Discharge Planning
Team Meetings, Staffings, Care Conferences
Our students are expected to be in their field placements Monday, Wednesdays and Fridays from 9 am to 5 pm.
Do these hours match your agency needs?
If you selected no, what days/hours do you need an intern for?
Consider what opportunities you may be able to offer our social work students, then respond to the following questions:
Please type or paste a description of your agency and what you do (mission statement, vision, values, goals, etc.). This description will be read by students.
Please type or paste the description of the intern position(s) your agency offers. This description will be read by students.
*You must read the following agreement and check the box in order to continue.
As a representative of my agency, I agree to provide an internship opportunity for the University of Wisconsin-River Falls Social Work Field Education Program. As a representative of my agency, I give the UWRF Social Work Field Education Program permission to share any information about my agency in order to arrange a field placement within my agency.
*To confirm you are human, please tell us what 1 + 1 equals:
University of Wisconsin-River Falls
410 S. 3rd Street, River Falls WI 54022 USA