Social Work Practice Fellows Application - UB School of Social Work Office of Continuing Education

Application

Social Work Practice Fellows Program - A Professional Development Program for Social Work Supervisors of Direct Practice Across the Life Course

Please complete all questions. You will be contacted once a decision on your acceptance is made. You register and pay after acceptance.

ELIGIBILITY: The participants selected for the program must be MSW-level social workers who are supervising social service workers from diverse settings. Supervisees can include any number of MSWs, BSWs, or other social service staff, in any combination.

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* 1. Please enter your work contact information.

First & Last Name

Full Agency Name

Complete Agency Address

City/Town

State/Province

ZIP/Postal Code

Work Phone Number

Email Address

Cell Phone Number

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* 2. Do you have an MSW degree?

Yes

No (You are not eligible if the answer is 'no'.)

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* 3. What is your current social work licensure status?

LMSW

LCSW

LCSW-R

not currently licensed

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* 4. Are you currently working as a supervisor?

Yes

No (You are not eligible if the answer is 'no'.)

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* 5. Are you agreeing to attend all 6 SWPF workshops?

Yes

If your answer is "no", please add clarification.

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* 6. Are you agreeing to complete both pre- and post-program self-assessments of supervisory practices? (All survey data will be de-identified and reported only in aggregate. Your name will not be linked in any way with your responses to this survey.)

Yes

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* 7. Specify the type of setting you currently work in as a supervisor (select all that apply).

Addictions services setting

Aging services setting

Children and family services setting

Criminal justice services setting

Disability services setting

Health care services setting

Housing or homelessness services setting

Mental health care services setting

Veterans services setting

Other services settings (please specify)

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* 8. Please provide a single number to represent your best estimate of the annual total number of clients collectively served by you and the people you supervise (your team). Answer with a specific estimate number (i.e. 250), not a range of numbers.

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* 9. Please answer the items below about supervision and supervisees.

Number of years working at the organization where you are a supervisor

Number of years serving in a supervisory role at the organization where you work

Number of years serving in a supervisory role throughout your career

Total current number of social work and social service supervisees

Current number of MSW social work supervisees (MSWs, LMSWs, LCSWs, and/or LCSW-Rs)

Current number of BSW social work supervisees

Current number of other staff you supervise

Thank you! We will acknowledge receipt of your application by email. Acceptance decisions will be made within 2-3 weeks of receipt of each application. You will be notified by email of the acceptance decision. For those accepted, instructions will be provided on how to pay by check, purchase order, or credit card.
Price: Early bird discount is $625 by 8/11/18; $700 after 8/11/18. No additional discounts may be applied to the program price.