THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Tate-Turner-Kuralt Building, 325 Pittsboro Street, Chapel Hill, NC 27599-3550 (919-962-6442)

Departmental MSW APPLICATION
School of Social Work		 Year: , Term: 1st Sum Session (adv standing only)
Fall Semester

Applicant's Full Name:
Last First Middle

Date of Birth: (mm/dd/yy)

NC County of Residence:

Address:
Street City State ZIP

Home Phone:  Work Phone:

Cell Phone:

E-Mail:

APPLICATION CATEGORY (Check One Program ONLY)

If you want to apply to the MSW/Ph.D. Continuum program, DO NOT USE THIS FORM - call the Doctoral Program secretary at 919-962-6477 for the appropriate form. Applicants can apply to only one social work program per year. Materials for both the Graduate School application and the Social Work MSW supplemental application MUST be received by January 16, 2008.
Advanced-Standing
available to BSW's only		 (Code SW SOWA)
Advanced-Standing Distance Education (Winston-Salem)
available to BSW's only		 (Code OS SWEX/WT)
Full-time Program
(in Chapel Hill)		 (Code SW SOWO)
Full-time Dual Degree Program (Code SW SOWO)
    Check one: MSW/MSPH
      MSW/Law
      MSW/MPA
      MSW/MDiv
Off-Campus Distance Education Program  
    Check one off-campus location: Triangle area (Code OS SWEX/DX) (Raleigh-Durham-Chapel Hill)
    Asheville (Code OS SWEX/AX) (only odd yrs. 2009, 2011, etc.)
    Winston-Salem (Code OS SWEX/WX)

Note: Please make sure you only checked ONE program. The off-campus location is only for Off-Campus Distance Education programs. If you want to disable the selection, click Reset button on the form.

CONCENTRATIONS AND FIELDS OF PRACTICE IN WHICH YOU ARE INTERESTED (Check ONLY one)
Direct Practice Concentration Management and Community Practice Concentration
Aging Aging
Health and Mental Health Health and Mental Health
Families and Children Families and Children

Other(specify)

 Broad-Based Human Services

Have you applied to our program prior to this year? No Yes
If yes, specify year(s):

SOCIAL WORK RELATED EXPERIENCE
Paid Employment in:
Full-Time
Part-Time
Dept. of Social Services (Family and Child Welfare) Years Months Years Months
Mental Health
Services to Elderly
Health Services
Drug and Alcohol Addiction
Violence Prevention/Treatment
Administration of Social Programs
Other:
Other:

Volunteer Social Work Related Experience:

1.

2.

Social Work courses you have taken at UNC-Chapel Hill through Continuing Studies as a non-MSW candidate:

Course Name Semester/Yr.

Course Name Semester/Yr.

Factors which influenced your decision to apply to the UNC-Chapel Hill School of Social Work:
Attended a Career Day/Graduate School event. I attended an information session at UNC-Chapel Hill.
I know your graduates and respect them. The program of study suit my interests.
The location suits my needs. Peterson's Guide or other Graduate School catalog.
Excellent reputation of School of Social Work. Other (Specify)

If you are applying to the Advanced Standing Program, you MUST also submit two additional documents: the Field Information form, which can be downloaded from this Web site; and a Field Evaluation form from your undergraduate school.

If you are applying to the Distance Education Program in Asheville, Winston-Salem or the Triangle area, you MUST submit a one-page document which answers each of the following questions.

  1. Tell us why you chose this location to pursue your graduate studies?

  2. Are you employed in a human services position?
    If yes, state where (agency and city), and describe your job responsibilities.

    If not, how do you plan to acquire the human services experience that will be necessary for you to do class assignments such as case summaries, process recordings and organizational analyses?

  3. If employed, what arrangements have you made to attend classes one day a week ? (Classes are held Fridays at all locations.)

  4. Have these arrangements been approved by your agency supervisor and director?

    If not, explain?

  5. In what region of the state or country do you hope to practice after receiving your MSW?

  6. This question is only for applicants to the Asheville, Triangle and Winston-Salem Distance Education programs (For Winston-Salem, only Direct Practice Concentration applicants need to answer):

    In the third year of study, you will be expected to be in class two days a week in Chapel Hill, in addition to three days a week in a field placement. Though the field placement might be arranged in your geographic location, how are you planning to arrange the third year of full-time study in Chapel Hill? What accommodations will your employer make so that you can complete the third year of full-time study?

  7. This question is only for applicants to the Winston-Salem Traditional Distance Education program (Management and Community Practice Concentration only):

    You will not need to arrange for full-time study in Chapel Hill because you will complete all degree requirements in Winston-Salem. Describe why you are interested in pursuing the Management and Community Practice Concentration and what types of experiences you would hope for in your field placement.

Revised June 4, 2007

The Application materials I am hereby submitting to the School of Social Work and the Graduate School are correct and factual to the best of my knowledge. I understand my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after enrollment.