Qualtrics Survey | Qualtrics Experience Management

Agency Profile Form

Agency name

Address

Telephone number

Website

Contact name

Email address

Agency status

Type of agency

Primary population served

Year the agency was established

Are social workers employed by the agency?

Yes
No

If yes,

BSW
MSW
Both

If no social workers are employed by the agency, what are your thoughts or plans for providing the required social work supervision for this field placement?

What is the agency's mission?

What types of social work tasks and learning activities would a student be able to expect at the agency?

How many hours per week could the agency support the learning activities for a social work student?

Why does the agency want to serve as a social work field site for Winthrop University?

Are there any pre-placement or on-boarding requirements for the student and/or University to complete prior to starting in the agency? Please describe in detail.

Please provide any additional information you feel would be helpful to prospective students.