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School of Social Work
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University of Maine School of Social Work Agency Information Form
University of Maine School of Social Work Agency Information Form
"
*
" indicates required fields
Agency/Program Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Program Office Phone
*
Website
Agency Internship Coordinator/Contact Person
*
Name of person who coordinates Internships for agency
Position/Title?
Pronouns?
Phone
*
Email
*
Please provide a link to any online internship applicaiton
Agency Internship Application Deadline(s)?
Is this Internship Remote, In-Person, or Hybrid?
*
Remote Only
In-person Only
Hybrid
Please list the geographic areas where you are able to host students:
*
Levels of Students Accepted?
*
Please select all that apply
BSW Students (400 hours over 2 Semesters)
MSW Generalist Year Students (400 hours over 2 Semesters)
MSW Specialization Year Students (500 hours over 2 Semesters)
Not sure yet
On average, how many students do you accept per year?
BSW Students
MSW Generalist Year Students
MSW Specialization Year Students
Add
Remove
What kind of supervision is available to students?
*
Check all that apply
BSW supervisor with two years of practice experience available
MSW supervisor with two years of practice experience available
Another degreed supervisor but not a BSW or MSW
No capacity to provide supervision
Student Supervisor Same as Agency Internship Coordinator?
Select One
Yes
No
If not the same, please list name and contact information for student supervisors (or those interested in being a student supervisor).
Please describe the student experience in the internship. What can students learn, observe, and do in this internship?
*
Please comment on the agency's commitment to anti-racism, diversity, equity, and inclusion in practice. How is this commitment demonstrated in the agency?
Please describe the type of student learner who would do best in this internship setting.
Please comment on any safety risks for students in the Internship. How do you ensure student safety? How do you train students about safety risks?
Please list what student(s) will need before beginning an internship. (Examples include, but are not limited to, an application; background check; immunization records; a particular credential; active CPR/First Aid certification; and/or attending a required agency orientation)
Please list typical student schedule, including working hours
*
Please select all of the following that apply to this internship:
*
Internship is accessible via public transportation
Car needed during Internship (*Note, students may not transport clients unless employeed)
Mileage is reimbursed
Expenses are reimbursed
Physical space is ADA accessible
Reasonable accommodations available for persons with disabilities
Can accomdate students looking for Intensive Summer Block (40 hours per week, M-F x 14 Weeks)
Can accomdate students looking for ONLY Evenings & Weekends
Is this internship Funded?
*
Unfunded Internship
Funded Internship: Stipend
Funded Internship: Employment
If stipend or employment compensation available, please provide details
While your agency may serve many populations or purposes, please choose the ONE category that best describes the agency's work.
*
Administrative SW
Aging/Gerontological SW
Child Welfare
Children, Youth, Families
Community Development/Planning
Corrections/Criminal Justice
Domestic Violence/Sexual Assault
Disabilities
Environmental SW
Housing Insecurity/Homelessness
Health/Medical
Home Health/Hospice
Immigration/Refugee
Inpatient Mental Health
Integrated Behavioral Health
International SW
LGBTQ
Legislative/Policy
Military/Veteran Services
Outpatient Mental Health
Research/Program Evaluation
School
Substance Abuse Disorder
Public Welfare
Tribal
Other
Please list any other information it would be important for students to know about this internship.
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