Qualtrics Survey | Qualtrics Experience Management

Hello prospective field instructor. Thank you for taking the time to complete this very important step in becoming a field instructor for the University of Memphis' School of Social Work. This form will take approximately 10-15 minutes of your time, and requires a resume/CV upload at the end. We need this information on file for our accreditation purposes.
Once you fill this out, please navigate back to our Community Field Resources webpage, and click to complete (or register for, depending on the time of year) our field instructor training for the current academic year.

Contact information

Your Full Name

Your work email address (will be used as your Tevera login)

Agency Name

Full Name of STUDENT you will be a field/task instructor to (if unknown, please put "TBD")

About You

Job Title

Number of Years With Agency

Full or Part-Time?

Have you had prior social work field instruction experience? (Y/N)

If licensed/certified, please provide certification and number (i.e., LMSW TN #12345)

Area(s) of specialization

Educational Background

Terminal Degree Earned

Year Graduated

Name of School

Location of School (city/state)

Area(s) of study

Undergraduate or other degree(s) earned (if applicable- please include all information as seen above)

Prior Work Experience - please indicate work experience prior to current position. A resume should be uploaded with this survey form.

Agency Name

Agency Address

Job Title

Full or Part-Time?

Length of Time With Agency

Were you a social work field instructor at this prior position? (Y/N)

Please upload your most recent resume or CV. This is required to be on file per CSWE accreditation standards.