Qualtrics Survey | Qualtrics Experience Management

Field Instructor Profile Form

Information provided on this form will not be shared with students without your approval.

1. Name

2. Date

3. Position Title

4. Agency

5. Office/Cell phone number

6. Email

7. Please briefly describe your primary job duties/responsibilities

8. What is your typical work schedule?

9. Educational background: degree, institution, and year awarded. Please also include any certifications or professional affiliations

10. Please upload a current résumé OR fill in employment/social work experience in the next question.

11. Employment/Social Work experience: Organization/Company, Role, Time in position

12. Have you previously been a field instructor for a social work student?

13. If so, with what university?

14. Please share with us any ideas or suggestions on what we can do to help make this field experience as successful as possible.