University at Albany -
School of Social Welfare
Return completed application and one copy of your resume to: Linda Mertz, Coordinator, Albany Internships in Aging Project, School of Social Welfare, University at Albany, 135 Western Avenue, Albany, NY 12222.
Please type or print information clearly
Name: Social Security Number:
Mailing
Address: ____________________________________________________________
City/State/Zip
code: __________________________________________________________
Telephone:
______________________________ Email:
___________________________
Your
current student status: ______
I am applying for the MSW program ( ___ Full time; ___ Part time)
______ I
am applying for the MSW Advanced Standing Program
______ I
am currently in the MSW program ( ___ Full time; ___ Part time)
When
will you be ready to start the second field placement? Year ______________
I
am applying for ______IAP only
______IAP plus oncology fellowship
Please
briefly address the following questions on a separate page (one paragraph per
question)
For those entering the advanced or second year of the Albany IAP (usually the 2nd year of the MSW program), please provide us with the name of your first year field instructor or other social work supervisor as a reference.**
** If applying prior to your first year, you can give us your field instructor’s name at a later date.
To
be considered for the Albany Internships in Aging Project, you must be
in good standing in the MSW program. (By signing below, you give us
permission to contact your reference, access your student file, and share
information about your background with project staff and potential field
instructors with the Albany Internships in Aging Project.)
Student
Signature: __________________________________ Date:
____________________