Indiana University School of Social Work S651/652 MSW PRACTICUM II - III (9 credits) Practicum Application FORM Date Submitted: Student I.D. #: Last Name (type below) First Name (type below) Email: (type below) IU Account Only Street Address (type below) City, State (type below) Zip Code (type below) Home Phone (type below) Work Phone (type below) Cell Phone (type below) Concentration Placement Year ______/____________ Place of Employment: Child Welfare Month and year you plan on starting Scholars Concentration Practicum Non- scholars Health Placement Options 640 HOURS – Leadership Two Semester 16 hrs/16 weeks Mental Health 24 hrs/16weeks) Date Started: – Schools Two semester 20 hours/32 weeks Two semester Extended 16 hrs/40 weeks One Semester Block (40 hrs/16 weeks) PLAN on: Employment Based Practicum/Petition to follow International
Indiana University School of Social Work S651/652 MSW PRACTICUM II - III (9 credits) Practicum Application FORM Date Submitted: Student I.D. #: Last Name (type below) First Name (type below) Email: (type below) IU Account Only Street Address (type below) City, State (type below) Zip Code (type below) Home Phone (type below) Work Phone (type below) Cell Phone (type below) Concentration Child Welfare Scholars Non- scholars Health Leadership Mental Health Schools Placement Year ______/____________ Month and year you plan on starting Concentration Practicum Placement Options – 640 HOURS Two Semester 16 hrs/16 weeks – 24 hrs/16weeks) Two semester 20 hours/32 weeks Two semester Extended 16 hrs/40 weeks One Semester Block (40 hrs/16 weeks) PLAN on: Employment Based Practicum/Petition to follow International Place of Employment: Date Started: