FOUR PART APPLICATION TO THE SOCIAL WORK MAJOR: ‘Complete and submit all four (4) sections of the application to the soci online survey. This includes: Part One: Demographic Information (#1 through #20) Personal Statement (#1 through #9) Field Application (#1 through #9) Acknowledgment and signature page (electronic signature is accepted) work major in this The deadline to submit this application is Monday, September 25, 2017. Late submission, or if any part of the application is missing, will result in conditional admission to the social work major. PART ONE: DEMOGRAPHIC INFORMATION 1. Name: flast, first, middle] Workman, Tina Renee 2 Student ID #: 1103078 3. Location (ex: Gainesville, Tampa, etc.): Tampa Education Center 4, Date of application: October 17, 2017 5. Expected date of graduation: May 2019 6. Age: 42 7. Local address during school year: 1027 $, Duncan Avenue, Clearwater, FL 33756 8. Local phone number: 678-710-4808 9. Person to notify in case of emergency: [name, address, phone number] Robert (Bob) Workman — Spouse 1027 S. Duncan Ave Clearwater, FL 33756 408-398-9255 (mobile number) 10. Ethnic/Racial Background: White (non-Hispanic) African American/Other Black Chicano/Mexican American Puerto Rican Other Latino/Hispanic American Indian/Native American Asian American/Other Asian Pacific Islander OtherMultiple Race/Ethnicity Unknown 11. Are you a foreign student (no resident visa)? YES__--s NO_X. 12. Do you require any accommodations under section 504 of the rehabilitation act or the Americans with Disabilities Act? YES. NO_X___[ifyes, please explain.] 13, Previous college(s) attended [if applicable}: Lanier Technical College (Cumming, GA) and Hillsborough Community College (Tampa, FL) 14, Practicum experience while attending previous college(s): [if applicable] Metropolitan Ministries ~ Tampa, FL (200 Hours) Project Return — Tampa, FL (200 Hours) 15, Interests and hobbies: Reading, travel, and spending time with family 16. Types of volunteer experiences and/or civic or social groups affiliated with: [other than required practical * Girl Scouts of America Troop Leader and Co-Leader (3 years) and handled registration for troops and girls 17. Do you have transportation for field placement? [Explain in detail.] Yes, I have my own personal vehicle in good running condition. 18, Are there are personal circumstances of which you are aware that could possibly affect your ability to complete the requirements of the social work program? Yes No_X [If yes, please explain in detail.] Loan Debt Please provide information about loan debt. CSWE and the National Association of Social Workers (NASW) use this critical data in advocacy and public work. 19. Will you or have you acquired loan debt while working towards your BSW? YES _X__NO 20. If you answered YES to the above question, what do you anticipate will be the average amount of your loan debt (acquired while working towards your BSW) when you graduate? (Please indicate the amount) $_50, 000 Part Two is on the next page 42PART TWO: PERSONAL STATEMENT This is to be a double spaced, typed personal statement essay. This essay should describe any relevant personal experience or background that brought you to the decision to enter the social work profession. Please include in your personal statement the following eight items: 1. Reasons for choosing to attend Saint Leo University Reasons for choosing to major in social work Perceived qualities and strengths that will benefit you as a social worker Professionally, your expectations of what you hope to be doing five years after graduation Educational experiences (if applicable) 6. Any relevant life experiences 7. Any relevant family history and relationships 8. Any other relevant information My passion and determination for social work has been ingrained in me long before I realized it, or really even understood what it was. I was always the child bringing home animals, much to my parent's dismay. Protecting the weaker students at school and befriending the lonely or bullied was a priority for me. I could not handle watching these things happen around me without speaking up ot taking action to help. I seemed to always have more of an open mind than most of my southern Texas family members, which was not always a good thing in my household. Life as a child and adolescent was difficult and chaotic within my home. Alcohol and physical abuse within my parental figures caused many consequences that my brother and I paid for dearly. We experienced emotional abuse 43and were not protected as we should have been, which had ever lasting impacts on both of us in different ways. My true journey to this program began only when I broke the cycles of abuse and sought help to recover from the abuse and trauma of my youth. This made me realize that one person can make a difference in the world, for my life was completely changed for the better by one LCSW. My qualities of empathy, life experiences, listening skills, and ability to talk to anyone will be strengths to utilize in my career going forward. Leveraging these strengths with my education will put me in a position to become an effective social worker in partnering with clients to achieve successful outcomes in their goals and lives. I have utilized my education from Hillsborough ‘Community College and personal strengths to complete two successful internships at local agencies in Tampa, Florida, Throughout the process of completing my internships, I was able to put what I Jeamed to actual use and partner with clients to set and reach goals. I was able to draw from my education to form employment and domestic violence groups for women at the homeless shelter. I effectively implemented and led classes for members of a day program for adults with mental health. diagnoses that focused on journaling on thoughts, personal hygiene, and current events. I am also aware of some of my weaknesses, such as self-care, which is going to be something I have to make a priority in my life. Due to life experiences, I have identified populations that I know I would not work with as well, which includes child abuse of any kind. Boundaries and emotional self-care would be a problem that could be career ending for me. I do not despair over this though, as I know that being aware and honest to myself, and others, about this is the best way to be an effective social worker in my career. There are plenty of other populations that are in dire need of support and care. Choosing Saint Leo University was not a hard decision for me to make. Besides respecting the core values of the university, the social work program is accredited, the university has an articulation agreement that works with my education from Hillsborough Community College, and the classes were interesting to me. I plan to take advantage of the advanced standing status available 44after my BSW graduation and continue on to graduate school for my Masters in Social Work through the online course that Saint Leo offers. Five years from now, I hope to have completed or be close to completing the requirements to become a licensed clinical social worker. I would like to work with pediatric oncology patients and their families through a hospital similar to Moffitt Cancer Center or ‘Tampa General Part Three is on the next pagePART THREE: FIELD APPLICATION Do you have any personal obligations which may prevent you from completing your field internship? If yes, please explain. No. Special Qualifications: [check those applicable] Driver's License _X__ Computer Literacy __X Foreign Language Do you have any physical, psychological, or emotional health issues which may interfere with you fulfilling the requirements of the field internship? Thave a hard time emotionally with child physical and sexual abuse. Itis the student’s responsibility to provide transportation for the field internship. Explain how you plan to fulfill this responsibility. Thave my own personal vehicle in good running order. If my vehicle breaks down, I will rent a car or use a taxi/Uber car hire. Do you understand that there are no funds available from the University for any expenses related the field internship and that you will be expected to finance all travel, housing, and food expenses involved in your intemnship? Yes _X No ‘Type of population/social issue preferred. List three (3) in order of preference. This does not guarantee that you will be able to be placed in your first choice. This serves as a guide for field staff. Students do not find their own field placements. 1. Pediatric Oncology (or Adult) 2. General Medical 3. Substance Abuse If you are working during the semester of your field placement, what arrangements have you ‘made to complete the required field placement hours? Tam not employed outside the home. Have you ever been arrested and/or convicted of any criminal offense? If yes, please explain. Yes No_X Please check ALL that apply to you: 46|. Preferred Number of Hours Per Week to Complete Internship X__ Complete 32 hours per week (full-time) — Completion in one semester Complete 16 hours per week (part-time) ~ Completion of remaining hours ‘over the second semester. . Preferred Time of Day to Complete Hours X__ Monday — Friday Day — Recommended hours are 8:00am — 4:00pm X_ Monday — Friday Evening - Recommended hours are 3:00pm — 11:00pm Saturday ~ Sunday Day — Recommended hours are 8:00am ~ 4:00pm, . Preferred Distance from Internship to Place of Residence X__Less than 10 miles __X_ 20-30 miles X__ 10 miles — 20 miles More than 30 miles |. Preferred Geographical Area of Internship: Rural Urban X_Bither .. Preferred Focus of Population Individual Clients (Micro) Groups (Macro) Community Work/Advocacy (Macro) Part Four is on the next page 47PART FOUR: ACKNOWLEDGEMENT AND SIGNATURE PAGE Please understand this application does not mean you have been admitted into the social work major and/or for a field placement. During this semester, your application will be reviewed by the Social Work Professional Standards Committee and you will subsequently participate in an interview with a member of that committee. You will receive official notification re: your admission status once grades are posted at the end of the semester. ‘The Social Work Department reserves the right not to admit a student to the social work major; not to place a student in the field; or to remove a student from field placement if the student demonstrates academic failure, exhibits unprofessional conduct or inappropriate behavior in the sroom or related in the field placement, In rare cases, agencies have requested that a student be removed from field placement due to the student's unacceptable behavior. In such a case, students will not be offered another field placement, Falsification or withholding of information on this application may result in denial to the social ‘work major, denial of a field placement, removal from field placement or removal from the major. If changes take place after the this application is first submitted, the Department Chair and/or Director of Field must be immediately notified in writing what those changes are, particularly ifthe student has subsequently been arrested or convicted of a crime. This page (Part Four) must be signed (electronically) and submitted with Part One, Part Two and Part Three of this application to the social work major. 1, ____ Tina Renee Workman have read in its entirety the (full name) Social Work Student Handbook, 2017-2018 and am aware of my rights and responsibilities which govern my acceptance into this program. Signed: Vina Len oe Whoa Date: October 17, 2017 The deadline to submit this application is Monday, September 25, 2017. Late submission, or if any part of the application is missing, will result in conditional admission to the social work major. 48