Waiver for Practicum I Application

Un-Paid Work History Form

Definition of Human Services Experience:

Human service is defined as providing social work related services to individuals, families, groups or communities. This could include 1) working with people in educational, correctional, social service agencies, health or recreational settings; 2) group and community participation and leadership; and 3) social change activities such as advocacy, research, education and social action.

Please fill in an application for each employer, beginning with your present or most recent employer, your paid human services work experience. Unpaid experience does not include practicum hours undertaken in a previous education program.

For each job please include:

In the comment box below, indicate in 1000 words or less:

    1. the nature of your work
    2. the level of responsibility
    3. the skills required to perform the duties of the position
    4. discuss how this position contributed to specific learning in the following areas:
      • Developing an overview of and ability to utilize a range of services available in the community.
      • Understanding and applying the ethical principles and core values of the social work profession.
      • Evaluating one’s own values and life experience and identifying how these influence practice.
      • Recognizing the extent to which a culture’s structures and values may oppress, marginalize, alienate, or create or enhance privilege and power, with specific attention to issues of race, class, gender, age, ability, sexual orientation, religion and culture.
      • Understanding the relationship between personal issues and social, political and economic processes and structures.
      • Demonstrating awareness of and sensitivity to issues of power at all levels (i.e. at the level of the social work relationship, organizational level, community level, and societal level).
      • Identifying different models of social work practice.
      • Demonstrating entry-level social work skills, such as engagement, assessment, planning, implementation, termination, and evaluation.
      • Identifying research and policy issues that affect practice.
      • Demonstrating initiative and responsibility for own learning.
      • Using supervision and consultation.

  • Student Information

  • Unpaid Work Place Information

    Note: you must submit the employer section for each employer you are listing as part of your waiver application. A link to the supplementary form will be available to you after you submit this application.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Multiple the number of weeks by the hours per week for this number.
  • limit of 5000 characters (approx. 1000 words). Make sure you have covered each items noted above.
  • Max. file size: 15 MB.

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