NCSSS Field Instructor Profile

1. Demographic information

Thank you for completing this required form on-line. Please note that if a question is starred (*), a response is required.If you have any questions, feel free to call us at 202-319-5457, or to email us at saks@cua.edu. We look forward to working with you,
Loretta

1. Please complete all information below:

Please complete all information below: Name:
Agency:
Address:
Phone Number:
City/Town:
State:
Zip Code:
Email address:

Feel free to skip any sections that follow when the information is included on your resume AND you can email your resume to us at: sola@cua.edu - thanks.

2. Your position at agency:

Your position at agency:

3. Please indicate dates of employment:

Please indicate dates of employment:

4. Function of organization or agency:

Function of organization or agency:

5. Summary of your duties:

Summary of your duties:

6. If you have supervised students before, indicate from what schools as well as level(s) of students (i.e. BSW, 1st year MSW, 2nd year MSW) you supervised:

If you have supervised students before, indicate from what schools as well as level(s) of students (i.e. BSW, 1st year MSW, 2nd year MSW) you supervised: