{"id":587,"date":"2017-04-06T10:22:23","date_gmt":"2017-04-06T14:22:23","guid":{"rendered":"https:\/\/sites.temple.edu\/sswfieldeducation\/?page_id=587"},"modified":"2024-05-14T16:29:37","modified_gmt":"2024-05-14T20:29:37","slug":"fieldtask-instructor-profile","status":"publish","type":"page","link":"https:\/\/sites.temple.edu\/sswfieldeducation\/fieldtask-instructor-profile\/","title":{"rendered":"Practicum Instructor Profile"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_10' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/sswfieldeducation\/wp-json\/wp\/v2\/pages\/587' data-formid='10' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_10_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_1'>\n                            \n                            <span id='input_10_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_10_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_10_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_10_28\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Contact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_28'>\n                            \n                            <span id='input_10_28_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.3' id='input_10_28_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_28_3' class='gform-field-label gform-field-label--type-sub '>Business phone<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_28_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.6' id='input_10_28_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_28_6' class='gform-field-label gform-field-label--type-sub '>Email<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_10_39\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Internship Coordinator<\/label><div class='gfield_description' id='gfield_description_10_39'>If your agency has assigned a coordinator for your field practicum please provide their information. If this person is you, please indicate.<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_10_39'>\n                            \n                            <span id='input_10_39_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.3' id='input_10_39_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_39_3' class='gform-field-label gform-field-label--type-sub '>Name<\/label>\n                                                <\/span>\n                            <span id='input_10_39_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.4' id='input_10_39_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_39_4' class='gform-field-label gform-field-label--type-sub '>Business phone<\/label>\n                                                <\/span>\n                            <span id='input_10_39_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.6' id='input_10_39_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_39_6' class='gform-field-label gform-field-label--type-sub '>Email<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_10_27\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Agency<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_10_27'>\n                            \n                            <span id='input_10_27_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.3' id='input_10_27_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_27_3' class='gform-field-label gform-field-label--type-sub '>Agency Name<\/label>\n                                                <\/span>\n                            <span id='input_10_27_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.4' id='input_10_27_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_27_4' class='gform-field-label gform-field-label--type-sub '>Title\/Position<\/label>\n                                                <\/span>\n                            <span id='input_10_27_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.6' id='input_10_27_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_27_6' class='gform-field-label gform-field-label--type-sub '>Program<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_10_2\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Agency Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_10_2_1' value=''    aria-required='true'    \/>\n                                        <label for='input_10_2_1' id='input_10_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_10_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_10_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_10_2_2' id='input_10_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_10_2_3' value=''    aria-required='true'    \/>\n                                    <label for='input_10_2_3' id='input_10_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_2_4_container' >\n                                        <input type='text' name='input_2.4' id='input_10_2_4' value=''      aria-required='true'    \/>\n                                        <label for='input_10_2_4' id='input_10_2_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_10_2_5' value=''    aria-required='true'    \/>\n                                    <label for='input_10_2_5' id='input_10_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_10_2_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_10_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Practicum\/Task Instructor<\/h2><\/li><li id=\"field_10_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Which role will you serve for the practicum experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_36'>\n\n<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_36'>\n\t\t\t<li class='gchoice gchoice_10_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='Practicum Instructor - HAS A BSW OR MSW AND 2 YEARS POST-DEGREE EXPERIENCE (Practicum Instructors with a Bachelor&#039;s degree may only supervise a BSW student)'  id='choice_10_36_0'    \/>\n\t\t\t\t<label for='choice_10_36_0' id='label_10_36_0' class='gform-field-label gform-field-label--type-inline'>Practicum Instructor - HAS A BSW OR MSW AND 2 YEARS POST-DEGREE EXPERIENCE (Practicum Instructors with a Bachelor's degree may only supervise a BSW student)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='Task Instructor - DOES NOT HAVE A BSW OR MSW OR LESS THAN 2 YEARS EXPERIENCE (Task Instructors have expertise in an area that would benefit the student\u2019s learning goals; however, due to accreditation regulations, they cannot be Practicum Instructors)'  id='choice_10_36_1'    \/>\n\t\t\t\t<label for='choice_10_36_1' id='label_10_36_1' class='gform-field-label gform-field-label--type-inline'>Task Instructor - DOES NOT HAVE A BSW OR MSW OR LESS THAN 2 YEARS EXPERIENCE (Task Instructors have expertise in an area that would benefit the student\u2019s learning goals; however, due to accreditation regulations, they cannot be Practicum Instructors)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_35\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Are you interested in volunteering to be an offsite  Practicum Instructor for the upcoming academic year or in the future?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_35'>This is for practicums without a CSWE approved social worker. Offsite Practicum Instructors provide supervision in addition to what occurs at the agency.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_35'><li class='gchoice gchoice_10_35_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.1' type='checkbox'  value='Contact me for the upcoming academic year'  id='choice_10_35_1'   aria-describedby=\"gfield_description_10_35\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_10_35_1' id='label_10_35_1' class='gform-field-label gform-field-label--type-inline'>Contact me for the upcoming academic year<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_35_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.2' type='checkbox'  value='Contact me in a future academic year'  id='choice_10_35_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_35_2' id='label_10_35_2' class='gform-field-label gform-field-label--type-inline'>Contact me in a future academic year<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_35_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.3' type='checkbox'  value='Not interested'  id='choice_10_35_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_35_3' id='label_10_35_3' class='gform-field-label gform-field-label--type-inline'>Not interested<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Do you have a Social Work degree?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_10'>Check all that apply<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_10'><li class='gchoice gchoice_10_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Bachelor&#039;s in Social Work'  id='choice_10_10_1'   aria-describedby=\"gfield_description_10_10\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>Bachelor's in Social Work<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Master&#039;s in Social Work'  id='choice_10_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_2' id='label_10_10_2' class='gform-field-label gform-field-label--type-inline'>Master's in Social Work<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='I do not have a Social Work degree'  id='choice_10_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>I do not have a Social Work degree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_13\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which accredited Social Work Program did you graduate from (Bachelor&#039;s degree)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_13'>Bachelor's degree. \n\nThis information is being collected for purposes of satisfying Council on Social Work Education's (CSWE) verification of degree requirement. By checking this box, I certify that I have graduated from an accredited school of social work.<\/div><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_13_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_13_col_2' class='gfield_list_col_even' \/><col id='gfield_list_13_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\">Institution<\/th><th scope=\"col\">Date of completion<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_13_cell1' data-label='Institution'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_10_13\" aria-label='Institution, Row 1' data-aria-label-template='Institution, Row {0}' type='text' name='input_13[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_13_cell2' data-label='Date of completion'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_10_13\" aria-label='Date of completion, Row 1' data-aria-label-template='Date of completion, Row {0}' type='text' name='input_13[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_10_14\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which accredited Social Work Program did you graduate from (Master&#039;s degree)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_14'>Master's degree.\n\nThis information is being collected for purposes of satisfying Council on Social Work Education's (CSWE) verification of degree requirement. By checking this box, I certify that I have graduated from an accredited <\/div><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_14_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_14_col_2' class='gfield_list_col_even' \/><col id='gfield_list_14_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\">Institution<\/th><th scope=\"col\">Date of completion<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_14_cell1' data-label='Institution'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_10_14\" aria-label='Institution, Row 1' data-aria-label-template='Institution, Row {0}' type='text' name='input_14[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_14_cell2' data-label='Date of completion'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_10_14\" aria-label='Date of completion, Row 1' data-aria-label-template='Date of completion, Row {0}' type='text' name='input_14[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_10_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_23'>What is your primary area or specialization in social work practice?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_10_23' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_10_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have 2 years of post degree experience<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_15'>\n\t\t\t<li class='gchoice gchoice_10_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='Yes'  id='choice_10_15_0'    \/>\n\t\t\t\t<label for='choice_10_15_0' id='label_10_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='No'  id='choice_10_15_1'    \/>\n\t\t\t\t<label for='choice_10_15_1' id='label_10_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have a professional license?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_29'>\n\t\t\t<li class='gchoice gchoice_10_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='Yes'  id='choice_10_29_0'    \/>\n\t\t\t\t<label for='choice_10_29_0' id='label_10_29_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='No'  id='choice_10_29_1'    \/>\n\t\t\t\t<label for='choice_10_29_1' id='label_10_29_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_29_2'>\n\t\t\t\t<input name='input_29' type='radio' value='gf_other_choice'  id='choice_10_29_2'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_10_29_other' name='input_29_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_16\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Licensure<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_16_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_16_col_2' class='gfield_list_col_even' \/><col id='gfield_list_16_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\">Level<\/th><th scope=\"col\">State<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_16_cell1' data-label='Level'><input aria-invalid='false' aria-required=\"true\"  aria-label='Level, Row 1' data-aria-label-template='Level, Row {0}' type='text' name='input_16[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_16_cell2' data-label='State'><input aria-invalid='false' aria-required=\"true\"  aria-label='State, Row 1' data-aria-label-template='State, Row {0}' type='text' name='input_16[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_10_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Highest level of education completed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city ginput_container_address gform-grid-row' id='input_10_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_10_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_10_17_1' id='input_10_17_1_label' class='gform-field-label gform-field-label--type-sub '>High school\/College\/University<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_10_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_10_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_10_17_2' id='input_10_17_2_label' class='gform-field-label gform-field-label--type-sub '>Major<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_10_17_3' value=''   placeholder='mm\/dd\/yyyy' aria-required='true'    \/>\n                                    <label for='input_10_17_3' id='input_10_17_3_label' class='gform-field-label gform-field-label--type-sub '>Date of completion<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_10_17_4' value=''\/><input type='hidden' class='gform_hidden' name='input_17.6' id='input_10_17_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_10_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you ever been a Temple University School of Social Work Practicum or Task Instructor<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_18'>\n\t\t\t<li class='gchoice gchoice_10_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Yes'  id='choice_10_18_0'    \/>\n\t\t\t\t<label for='choice_10_18_0' id='label_10_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='No'  id='choice_10_18_1'    \/>\n\t\t\t\t<label for='choice_10_18_1' id='label_10_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_22\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please list previous experience (with any school) as a Practicum Instructor<\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_22_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_22_col_2' class='gfield_list_col_even' \/><col id='gfield_list_22_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_22_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Academic Year<\/th><th scope=\"col\">School<\/th><th scope=\"col\">Number of students<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_22_cell1' data-label='Academic Year'><input aria-invalid='false'   aria-label='Academic Year, Row 1' data-aria-label-template='Academic Year, Row {0}' type='text' name='input_22[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_22_cell2' data-label='School'><input aria-invalid='false'   aria-label='School, Row 1' data-aria-label-template='School, Row {0}' type='text' name='input_22[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_22_cell3' data-label='Number of students'><input aria-invalid='false'   aria-label='Number of students, Row 1' data-aria-label-template='Number of students, Row {0}' type='text' name='input_22[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/sites.temple.edu\/sswfieldeducation\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_10_19\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which level of student fits your agency best?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_19'>Choose all that apply<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_19'><li class='gchoice gchoice_10_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='BSW Generalist'  id='choice_10_19_1'   aria-describedby=\"gfield_description_10_19\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_1' id='label_10_19_1' class='gform-field-label gform-field-label--type-inline'>BSW Generalist<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='MSW Generalist (1st year)'  id='choice_10_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_2' id='label_10_19_2' class='gform-field-label gform-field-label--type-inline'>MSW Generalist (1st year)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.3' type='checkbox'  value='MSW Advanced - Clinical'  id='choice_10_19_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_3' id='label_10_19_3' class='gform-field-label gform-field-label--type-inline'>MSW Advanced - Clinical<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_10_19_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.4' type='checkbox'  value='MSW Advanced - Macro'  id='choice_10_19_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_19_4' id='label_10_19_4' class='gform-field-label gform-field-label--type-inline'>MSW Advanced - Macro<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Practicum\/Task Instructor training<\/h2><\/li><li id=\"field_10_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you attended the &#039;Getting Started in the Practicum&#039; seminar with Temple University?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_46'>\n\t\t\t<li class='gchoice gchoice_10_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='Yes'  id='choice_10_46_0'    \/>\n\t\t\t\t<label for='choice_10_46_0' id='label_10_46_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_10_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='No'  id='choice_10_46_1'    \/>\n\t\t\t\t<label for='choice_10_46_1' id='label_10_46_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_10_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_47'>In which year did you attend the &#039;Getting Started in the Field&#039; semiar with Temple University?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_10_47' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_10_30\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Have you attended other Practicum\/Task Instructor training?<\/label><div class='gfield_description' id='gfield_description_10_30'>Use the + to add additional lines<\/div><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_30_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_30_col_2' class='gfield_list_col_even' \/><col id='gfield_list_30_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_30_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">School that provided training<\/th><th scope=\"col\">Topic<\/th><th scope=\"col\">Date<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_30_cell1' 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