UVic SOCW PLA Application

To Apply for PLA you need include the Supervisor Evaluation Form as listed in the instructions on the website.

Supervisor Evaluation Form Attachment:

Anticipated PLA Term:

Your UVic Student ID Number:

Your First Name

Your Last Name

UVic Email

Confirm Email

Phone

Address

Employment and Volunteer Experience

Please select the nature of the experience:

Volunteer

Employment

Place:

Date From:

Date To:

Supervisor Contact Name:

Supervisor Contact Email:

Supervisor Contact Phone:

Description of Duties:

(Please be sure to make the connection to social work/social justice).

Number of Hours:

Minimum of 4000 hours (approximately 2 years full-time) of Social Work job or volunteer experience within the last 5 years.

Employment and Volunteer Experience

Please select the nature of the experience:

Volunteer

Employment

Place:

Date From:

Date To:

Supervisor Contact Name:

Supervisor Contact Email:

Supervisor Contact Phone:

Description of Duties:

(Please be sure to make the connection to social work/social justice).

Number of Hours:

Minimum of 4000 hours (approximately 2 years full-time) of Social Work job or volunteer experience within the last 5 years.

Employment and Volunteer Experience

Please select the nature of the experience:

Volunteer

Employment

Place:

Date From:

Date To:

Supervisor Contact Name:

Supervisor Contact Email:

Supervisor Contact Phone:

Description of Duties:

(Please be sure to make the connection to social work/social justice).

Number of Hours:

Minimum of 4000 hours (approximately 2 years full-time) of Social Work job or volunteer experience within the last 5 years.

To submit an application for PLA, you must answer “yes” to all of these questions:

As of the date on which I am submitting this application, I have a minimum of 4000 hours of social work like experience with in the previous 5 years.

Yes

No

A recent work supervisor (not colleague or co-worker) has completed the form and it is attached to this application.

Yes

No

The supervisor has agreed to participate in a telephone discussion of their evaluation with me and my PLA instructor (this will occur approximately ½ way through the PLA course).

Yes

No

Please check to confirm that you have read and accept these PLA policies:

I understand that if I do not meet the minimum requirements for practicum by PLA, I will be required to complete a 3rd year practicum.

I understand that completion of the 3rd year practicum by PLA requires timely participation in PLA via CourseSpaces, timely submission of all required materials, and that if I fail to participate, or fail to submit all required materials within designated time frames, I will fail PLA.

I understand that if I fail PLA, an “F” will appear in my transcript.

Your application has been sent. You should receive an email receipt. Thank you!