MSW Application

MSW Program Application

UPIKE Master of Social Work Banner

Completion of this application is only one of the admission requirements for the UPIKE MSW program. Please refer to the admission requirements to review the complete list of admission requirements.

If you have any questions or need assistance, please contact us at 606-218-5023 or socialwork@upike.edu.

Fields with * are required.

Your Information

Program Options: *

Accelerated Advanced Standing - One (1) year Advanced Standing - Two (2) years Regular Standing - Two (2) years Regular Standing - Three (3) years

Starting Semester: *

Fall 2023 Spring 2024 Summer 2024 Fall 2024

First Name: *

Middle Name:

Last Name: *

Maiden Name:

If applicable

Street or PO Box: *

City: *

State: *

Zip: *

Phone number: *

Email Address: *

Date of Birth: *

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Number: *

Social Security Number: *

Country of Birth: *

City and State of Birth: *

Citizenship: *

US Other (Specify)

Citizen Other:

Military Experience: *

Yes No

Dates of Service:

Discharge Status:

Will you be receiving assistance from the Veteran's Administration for the MSW Program? *

Yes No

Have you ever been convicted of a crime other than a minor traffic violation? *

Yes No

Are there any current criminal charges against you? *

Yes No

If yes, please upload an explanation in a single file outlining violation, date, consequences, and current status of conviction. Please note that the application cannot be processed without an explanation.

*Please note that acknowledgement of a criminal conviction does not necessarily mean your application is automatically denied. However, it is very important that the program know and understand the background as it can create issues in the field education component of the MSW program. More specifically, some practicum placement agencies will not accept students in their field placement if that student has a criminal background. Having a criminal background can also create problems with obtaining licensure. You should consult state law to determine if your criminal history may impact your ability to become a licensed social worker in the state where you intend to work.

Education

Beginning with the MOST RECENT, please list the colleges and universities from which you have received a degree.

College/University Name: *

City, State, Zip *

Attended From: *

Attended To: *

Degree Received? *

Yes No

Major: *

Minor, if applicable:

Final/Current GPA: *

Unofficial Transcript: *

NOTE: You are required to send an official copy of transcripts from degree granting institution(s), as well as transcripts from any graduate work to the University of Pikeville Registrar’s Office.

College/University Name

City, State, Zip

Attended From:

Attended To:

Degree Received?

Yes No

Major:

Final/Current GPA:

Unofficial Transcript:

Have you ever been disciplined by an educational institution? Includes probation, suspension, dismissal, or expulsion due to academic or behavioral misconduct. *

Yes No

If yes, please identify the disciplinary action and context for such action.

Demographics

The following information will be used for data collection/reporting only. Your response will not impact your admission.

Gender:

Male Female Non-Binary (Third Gender) Prefer not to say

Prefer to self-describe:

Pronouns:

Ethnicity:

White (non-Hispanic) African American/Black Chicano/Mexican American Puerto Rican Other Latino/Hispanic Native American/American Indian/First Nation People Asian American/Other Asian, Pacific Islander Multiple Race/Ethnicity Prefer not to say

Prefer to self-describe:

Are you the first in your family to attend college (other than sibling(s))?

Yes No

Have any of your family members attended the University of Pikeville?

Yes No

If yes, please provide relationship and name:

How did you hear about the UPIKE MSW Program?

REGULAR STANDING APPLICANTS ONLY:

If you do not hold a degree in social work or will not be completing a degree in social work from a program accredited by the Council on Social Work Education (CSWE), please list courses you have completed in the following areas to demonstrate that you meet the liberal arts requirements for admission. Please note that any liberal arts coursework not completed on admission to the MSW program, must be completed before beginning the advanced curriculum.

Six Hours of Social Sciences (sociology, psychology, communication, political science, economics, anthropology, and human geography).

Course Name

Grade Received/Expected

Course Number

Course Name

Grade Received/Expected

Course Number

Course Name

Grade Received/Expected

Six Hours in arts and humanities (philosophy, ethics, art, music, theatre, religion, foreign language, and literature/writing).

Course Name

Grade Received/Expected

Course Number

Course Name

Grade Received/Expected

Three hours in an introductory biology course or human based biology course.

Course Name

Grade Received/Expected

Six hours in the natural sciences or mathematics - Must include a course in statistics and one other math or natural science course.

Course Name

Grade Received/Expected

Course Number

Course Name

Grade Received/Expected

ADVANCED STANDING APPLICANTS ONLY:

Have you received your social work degree within the last eight (8) years? i.e. will there be less than eight (8) years between social work degree conferral and the date that you will start the UPIKE MSW program?

Yes No

An applicant holding an accredited social work degree conferred more than eight years prior to beginning the MSW program, may be considered if the applicant has consistently been employed in the field and/or consistently maintained a professional social work license. If this applies to you, please upload documentation of consistent employment since graduation and/or proof of licensure since graduation in a single document.

Employment/Proof of Licensure:

Did you receive a grade of B or better in all required undergraduate social work courses?

Yes No

If you did not receive a B or better in all required undergraduate social work courses, you can request special consideration by uploading a document which addresses the following: (1) Identify the courses where you did not recieve at least a B and identify the grade of record; (2) Describe any specific obstacles or circumstances that hindered your past academic achievement; (3)Describe how you overcome those obstacles or circumstances or how you plan to overcome these obstacles if you are admitted to the UPIKE MSW program.

Academic Special Consideration

Name, city, and state of the agency/organization where you completed your undergraduate practicum(s).

Total number of hours completed in the practicum placement(s):

Personal Statement

Upload your personal statement. The statement should be approximately four pages in length, double-spaced, and address the following:

Why have you chosen to study social work? Why are you seeking graduate education at this time? What are your career goals for the five years following graduation?
Describe prior experiences, if any, that you have had with online learning, identify any challenges you anticipate with completing an online MSW, and briefly discuss your strategies for academic success.
Discuss specifically how you will plan for and accommodate the required hours per week needed to completed the field hours while in the program. If you are expecting to be employed while in the program, discuss how you will ensure your availability for field placement hours.
What information influenced your choice in making an application to the UPIKE School of Social Work? How will you contribute to the UPIKE MSW program and to your peers?

Personal Statement: *

Resume

Current copy of your resume/CV: *

MSW Handbook Agreement

After reading the MSW Program Student Handbook, read each statement below and inital at the bottom to indicate your agreement with each statement.

I have thorougly reviewed a copy of the University of Pikeville School of Social work MSW Student Handbook.

If accepted into the MSW program, I will complete the MSW orientation course prior to beginning classes.

I understand that the MSW Student Handbook is a working document and is subject to change and revision and I am responsible for being aware of these changes.

I understand that adhering to the policies outlined in this handbook is my responsbility and that if I fail to do so, I am subject to consequences and I am responsible for seeking clarity of the policy(ies) if I have questions or concerns.

I have read the MSW Student Handbook and that I understand the content and policies outlined therein and I agree to adhere to them as long as I am a student in the MSW program at the University of Pikeville.

Initial * Required

Code of Ethics Agreement

Please read the National Association of Social Workers (NASW) Code of Ethics (COE). Once complete, review the following statements and initial below to indicate your agreement.

I have reviewed and understand the NASW COE.

I agree with, support, and commit myself to uphold the principles contained within the COE.

I understand that any violation of the NASW COE will be subject to consequences and may result in termination from the UPIKE MSW Program.

I understand that I am solely responsible for my conduct and I shall take responsibility for it.

I understand that "not knowing" an act is unethical or inappropriate is not an excuse for the behavior and I am still considered responsible for that act(s).

I understand that I am responsible for seeking clarity of the ethical standards and principles outlined in the NASW COE.

I agree to adhere to the NASW COE as long as I am a student in the MSW Program at the University of Pikeville.

Initial * Required

Background Checks and Drug Screen Agreement

Please read the following statements and initial below to indicate you agreement.

I am willing to submit to a background check, which may include federal and state criminal records, child abuse registries, sex offender registries, and other sources of information which may be necessary to determine my fit for placement in a practicum agency.

I am willing to submit to a drug screen which may be necessary to determine my fit for placement in a practicum agency.

I understand that the results of the background check(s) and/or drug screen may be shared with potential practicum agencies and supervisors in order to attempt to secure a placement.

I understand that I may be responsible for the costs of the background check(s) and/or drug screens.

I understand the results of the background checks and/or drug screens may create issues in the field education component of the MSW program. More specifically, some practicum placement agencies will not accept students in their field placement if that student has a criminal background and/or does not have a clean drug screen. If I cannot complete the field education portion of the program, I will not be able to complete the degree.

Initial * Required

Technology and Video Requirements

Please read the following statements and initial below to indicate your agreement.

I understand that the UPIKE MSW program is an online program and all my courses will be provided through a learning management system.

I understand that due to the online nature of the courses, I may be required to submit recorded video of myself as part of the program and/or class requirements.

I understand that I must have regular and reliable access to a computer and an internet connection and that it is my responsibility to ensure that I have the hardware (microphone, web camera, speakers, etc) necessary to fully participate in the program and courses.

I understand and agree that it is my responsibility to meet the technology and hardware requirements of the program. I also understand that computer/hardware problems or lack of access to a computer/internet connection do not serve as suitable excuses for not participating in the program or courses.

Initial * Required

Evaluators for Recommendation Forms

Admission to the MSW program requires three (3) recommendation forms from individuals who can provide information about your academic and personal qualifications related to graduate school readiness. Once you identify these individuals, we will send them a password protected recommendation form to complete and submit on your behalf.

Regular Standing - 60 hour program applicants: If you are currently enrolled in an academic program or have graduated within the last five (5) years, one of the recommendation forms must be from a former or current professor and the other recommendations will be accepted from individuals in any of the following categories:

Professor
Social Work Professor
Field Supervisor
Professional Social Worker
Work or Volunteer Supervisor

Advanced Standing - 30 hour program applicants: One recommendation must be from a field supervisor or current employer if working in a social work-related position and the other two recommendations will be accepted from individuals in any of the following categories:

Professor
Social Work Professor
Field Supervisor
Professional Social Worker
Work or Volunteer Supervisor

These recommendation forms will become part of your educational record. In accordance with the Family Education and Rights Privacy Act of 1974, you will have access to your record, including these forms unless you voluntarily waive your right to review the recommendation forms. Below you will list the name and email address of the three individuals you have asked to serve as an evaluator and complete the required recommendation forms. For each individual's recommendation form, you will indicate whether you waive your right to access the document. The School of Social Work does not require you to waive access. It is a personal decision and does not impact the admission decision. If you fail to mark one of the options, you will automatically waive your right to review the form(s).

Name of Evaluator One (1) *

Email Address of Evaluator One (1) *

Must be a professional email address.

Confirm Email *

FERPA Statement for Evaluator One (1) *

I have read the FERPA statement above and hereby WAIVE my right to access this document. I have read the FERPA statement above and hereby DO NOT WAIVE my right to access this document.

Name of Evaluator Two (2) *

Email Address of Evaluator Two (2) *

Must be a professional email address.

Confirm Email *

FERPA Statement for Evaluator Two (2) *

I have read the FERPA statement above and hereby WAIVE my right to access this document. I have read the FERPA statement above and hereby DO NOT WAIVE my right to access this document.

Name of Evaluator Three (3) *

Email Address of Evaluator Three (3) *

Must be a professional email address

Confirm Email *

FERPA Statement for Evaluator Three (3) *

I have read the FERPA statement above and hereby WAIVE my right to access this document. I have read the FERPA statement above and hereby DO NOT WAIVE my right to access this document.

General Affirmations

Please read the following statements and initial below to indicate your agreement.

I understand that once my application has been submitted that it may NOT be altered in any way and that once submitted all materials become property of the University of Pikeville and will not be returned.

I certify that all the information submitted in the application is factually true and my own work and that any untruthful or misleading information will result in the disqualification of this application and/or dismissal from the program should this be detected after admission.

I understand that the program has the right to interview any applicant.

I understand that an offer of admission is conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based.

Type full legal name and date * Required

Submitter Information

Name: *

Email: *

Comment:

Your Information (Page 1 of 14)

Prev Next

Autosave is currently ON

You can access this form using the following url:

https://apps.upike.edu/approval/live.php