MaSW Field Education Planning & Confirmation Form

Please send this form to the Field Work Coordinator at least 6 weeks before your placement is scheduled to begin.  It is important that you complete all sections of the form (incomplete forms will be returned and this might delay the approval process).  

Please note your placement is not confirmed until a letter from the University has been sent to the Field Educator confirming the placement.  You cannot begin the placement until University staff have completed this process.

Information about student involved

Student ID Number

Student First Name

Student Surname

Student Contact - Email

Student Contact - Phone

Student Address

Paper Number

Agency Information
Information about agency and focus of placement

Agency Name

'In Work' Placement


If this is an 'in work' placement, please state how your placement activities will differ from your normal work.

Focus of Placement

Start Date

(dd / mm / yyyy)

Finish Date (approx)

(dd / mm / yyyy)

Hours per Week

Field Educator Details

Field Educator - Name

Field Educator - Email

Field Educator - Phone

Field Educator - Postal Address

Agency Physical Address

Agency Phone Number

Agency Email

Field Educator Social Work and/or other professional Qualification (from where):

Are they a registered Social Worker?


SWRB registration number

For in-post placements only - is the Field Educator different from your current supervisor?


External Supervisor
Required when placement agency is unable to provide supervision from a Qualified Social Worker

External Supervisor - Name

External Supervisor - Email

External Supervisor - Phone

External Supervisor - Postal Address

External Supervisor Social Work and/or other Professional Qualification (from where):

Are they a registered Social Worker?


SWRB registration number

Placement Confirmation

Has the idea of a placement been informally approved by the placement agency and its management?


Who should Massey contact to formalise the proposed placement?

Name

Phone

Email

SWRB Reporting

What location is the agency in?  These locations are supplied from the SWRB reporting requirements

Is this a Government Agency?


What kind of Government Agency is it?  (If applicable)

If a Government Agency - is the Supervisor registered or not, and on site or not?

If a Government Agency - is the Secondary Supervisor Registered or not, On-Site or not?

If this is a Non Government Agency specify if Maori/Iwi based or not.

If a Non Government Agency please advise if supervisor is a Registered Social Worker or not and on-site or not.

If a non Government Agency is the Secondary Supervisor Registered or Not, on site or not.

OFFICE USE ONLY:

Placement Confirmed by:

Date:

Email Address

Massey Contact Centre Mon - Fri 8:30am to 5:00pm 0800 MASSEY (+64 6 350 5701) TXT 5222 contact@massey.ac.nz Web chat Staff Alumni News Māori @ Massey