Agency Application

UConn Practicum Agency Application

Thank you for your interest in partnering with UConn School of Social Work and the Practicum Education Department. Please take a moment to tell us a bit about your agency and unit. Once completed a staff person will follow up with you for additional information. and to start the affiliation agreement process. Please note that this application supports your partnership with the school but it does not guarantee that a student will be placed with your agency.

Is this a Private Practice?
First and Last Name
Please indicate the year and focus of study your department/unit will be open to consider (check all that apply)
Students may complete their practicum placements during different times a year; please indicate which times of year you are open to consider for placements (check all that apply)
Please check the times that you are open to interns earning their hours (check all that apply)
All Social Work students must receive an hour of supervision from an MSW practitioner. Please indicate if you have the following staff members currently on staff (check all that apply)
This field is for validation purposes and should be left unchanged.