ST. CATHERINE UNIVERSITY - UNIVERSITY OF ST. THOMAS SCHOOL OF SOCIAL WORK BSW AGENCY PLACEMENT CHOICE FORM Check all that apply: Junior Day St. Catherine (at time of placement) Senior CFA St. Thomas (at time of placement) Name: Full Address: Phone Number: University Email: Field Faculty Liaison: FIRST CHOICE AGENCY: 1. Agency: Address: Instructor: Phone Number: Reason: (Acceptable for Placement): SECOND CHOICE AGENCY 2. Agency: Address: Field Instructor: Phone Number: Reason: THIRD CHOICE AGENCY (Acceptable for Placement): 3. Agency: Address: Instructor: Phone Number: Reason: *Please add additional agencies choices and agencies that are unacceptable for placement on the next page. FOURTH CHOICE AGENCY (Acceptable for Placement):
ST. CATHERINE UNIVERSITY - UNIVERSITY OF ST. THOMAS SCHOOL OF SOCIAL WORK BSW AGENCY PLACEMENT CHOICE FORM Check all that apply: Junior (at time of placement) Senior (at time of placement) Day CFA St. Catherine St. Thomas Name: Full Address: Phone Number: University Email: Field Faculty Liaison: FIRST CHOICE AGENCY: 1. Agency: Address: Instructor: Phone Number: Reason: SECOND CHOICE AGENCY (Acceptable for Placement): 2. Agency: Address: Field Instructor: Phone Number: Reason: THIRD CHOICE AGENCY (Acceptable for Placement): 3. Agency: Address: Instructor: Phone Number: Reason: *Please add additional agencies choices and agencies that are unacceptable for placement on the next page. FOURTH CHOICE AGENCY (Acceptable for Placement):