School Social Worker Certificate Program Application

Non-Matriculated Student Application

For: Individuals either enrolled in a MSW degree program outside of Bryn Mawr or who have completed a master’s program in social work (or similar degree) at another institution.

SUGGESTION: Have your resume in hand as you complete the SSWC Application.

Note: This form will not save while you work on it. If you close this page and come back, your answers will not be saved.

Bryn Mawr College MSS students/alumnae/i are not to complete this application; but instead, complete the MSS Student SSWC Application.

Application Fee: $25.00 (At the end of the application, you will be prompted to enter your credit card information for the application fee.)

APPLICANT INFORMATION

Full Name *

Email Address *

Phone Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Birthdate * +

(Optional) For US citizens only, if you wish to be identified as a member of a racial/ethnic group please indicate:

Do you currently have a LSW?
(Note: For PDE Certification, you will be required to have a PA LSW or LCSW.)

Yes

No

Will you need us to place you in a school-based field education setting?
(NOTE: Additional course fee will be assessed if field placement services are handled by Bryn Mawr College GSSWSR. ) *

Yes

No

I am not certain and would like to discuss further.

Transfer/Waiver Credit: Coursework must have been completed within five years of the transfer credit request in order to be considered for transfer credit. Field placement tasks and responsibilities must align with that of a school social worker in order to be considered for waiver consideration.
(see website for details)

Do you intend to request transfer/waiver credit for coursework or field placement? *

Yes

No

I am not certain and would like to discuss further.

EDUCATION

EDUCATION

List in reverse chronological order all institutions of higher education attended.

Degree Field entry should reflect degree received. (For example, M.S.W., B.A., B.S.)

Education Institution Name (highest attained degree) *

Degree *

Degree Year *

Major

If you are currently enrolled in a MSW (or similar) degree program, do you intend to use your field placement setting for the school-based field practicum requirement?
NOTE: SSWC requires field practicum be in a PK-12 school-based setting.

Yes

No

I am unsure.

Not applicable.

If yes, does your field supervisor hold one of the following credentials?

PA Licensed Social Worker (LSW)

PA Licensed Clinical Social Worker (LCSW)

PA Home and School Visitor Educational Specialist Certification (HSV)

PA School Social Worker Educational Specialist Certification (SSW)

None of the above.

Education Institution Name

Degree

Degree Year

Major

EMPLOYMENT

Do you intend to use your current employment for the school-based field practicum requirement?
NOTE: SSWC requires field practicum be in a PK-12 school-based setting. *

Yes

No

I am unsure.

If you answered yes to the above question, please email your job description that includes details of your responsiblities to swprodev@brynmawr.edu

If yes, tell us about your supervisor. Does your supervisor hold one of the following credentials?

PA Licensed Social Worker (LSW)

PA Licensed Clinical Social Worker (LCSW)

PA Home and School Visitor Educational Specialist Certification (HSV)

PA School Social Worker Educational Specialist Certification (SSW)

None of the above.

Current Employer *

Current Position *

Direct Supervisor Name

Current Employment Email *

Current Employer Street Address *

Current Employer Address Line 2

Current Employer City *

Current Employer State *

Current Employer Zip Code *

EMPLOYMENT CONTINUED

List in reverse chronological (newest to oldest) order prior employment.

Other Employment Position

Other Employment Organization

Dates of Employment

Supervisor

Other Employment Position

Other Employment Organization

Dates of Employment

Supervisor

How did you learn about the Bryn Mawr College School Social Worker Certificate Program?

PROCEED TO PAYMENT

School Social Worker Certificate Program APPLICATION FEE: $25.00 (non-refundable)

Click here to proceed to payment page.

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