Name(Required) First Last City and State where you reside:(Required) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Email(Required) PhonePlease select one: Student Community Partner/Individual Which academic program are you currently enrolled in?(Required)BASW (in-person)BASW (online)MSW (hybrid)MSW (online)If known, For which field course are you seeking information?SW 444SW 445SW 640SW 740SW 741No course, just have a question about field placementsHave you completed the Student Field Orientation modules in the BASW or MSW advising courses in Canvas?(Required) Yes No Please review the Student Field Orientation modules in Canvas for detailed information related to field placements. Contact your academic advisor if you aren’t enrolled in the advising Canvas course.Please select a question topic.(Required)Please choose a topicTevera (registration, password reset)Assistance finding a field placementAssistance completing a field placement at an agency that is not already established with UK and requires an affiliation agreementNeed to postpone a field placementCompleting a block placementStarting a placement earlyOther question/topic (please enter your question in the box below)Not registered for Tevera: Provide agency placement information belowAgency Name(Required)Agency Contact Name(Required)Agency Contact Email(Required) Agency Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Other topic or question(Required)0 of 800 max charactersPlease select a question topic.(Required)Please choose a topicI am interested in hosting students in my agencyI am interested in serving as an off-site social work supervisor for a student in practicumI have already been contacted by a student who is interested in our agency and/or my services as a social work supervisorOtherOther topic or question(Required)Agency Name(Required)Agency Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Agency Website Name of social work student that contacted you.(Required) First Last Field Education About Field Education Current Students For Agencies Army-UK MSW
