Self-Referrals

A student can independently contact an agency to seek their own field placement, including making inquiries to determine if an agency is interested in an intern. If a student prefers this option the Student Self-Referral form must be submitted to the field office once a student has interviewed with an agency and received confirmation of acceptance. The Office of Field Education will contact the agency to ensure the quality of the placement, appropriate learning opportunities, and to establish a clear relationship between SSW and the agency.

After student interviews with a potential field agency, student must submit the following form to the appropriate field office for review and follow up. Completion of this form is not an automatic approval of the placement. This document can be used to have a discussion with your potential Field Instructor about the roles and responsibilities involved.


You can submit the Self-Referral Form below after you have:

  • Completed the Field application
  • Interviewed and have been accepted at this agency

Click the link below to complete the Self-Referral Form within 30 days of submitting your field application:

Student Self-Referral Form