Home and School Visitor Application for Non-Matriculated Students

Thank you for your interest in the Home and School Visitor program. Individuals who have completed a master’s program in social work or in a related field at Bryn Mawr or another institution apply as a non-matriculated student using the below application.

NOTE: Applicants will find it helpful to have their resume in hand as they complete the HSV Application.

Bryn Mawr College MSS students (currently enrolled) do not have to complete the HSV application; however, they must meet with the HSV Certifying Officer to discuss program requirements.

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

HSV Applicant

Full Name *

Name while at Bryn Mawr College (if former student)

Email Address *

Phone Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Birthdate * +

Are you a Bryn Mawr alumni?

Yes

No

Do you currently have a LSW?

Yes

No

Will you need us to place you in a school-based field education setting?

Yes

No

I am not certain and would like to discuss further.

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

EDUCATION - EMPLOYMENT - VOLUNTEER WORK

EDUCATION

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

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

Education Institution Name *

Degree *

Degree Year *

Major

Education Institution Name

Degree

Degree Year

Major

VOLUNTEER WORK

List volunteer activities during past five years.

Volunteer Assignment

Volunteer Organization

Volunteer Dates of Service

Volunteer Supervisor

Volunteer Assignment (2)

Volunteer Organization (2)

Volunteer Dates of Service (2)

Volunteer Supervisor (2)

EMPLOYMENT

List in reverse chronological order all employment during past five years.

Current Employer *

Current Position *

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 order all employment prior to your current position

Other Employment Position

Other Employment Organization

Dates of Employment

Supervisor

Other Employment Position

Other Employment Organization

Dates of Employment

Supervisor

Goals

GOALS: Tell us a little bit about how you plan to use the knowledge you will acquire from your study at Bryn Mawr. *

How did you learn about the Bryn Mawr College Home and School Visitor Program

Proceed to Payment

HOME AND SCHOOL VISITOR APPLICATION FEE: $25.00 (non-refundable)

Proceed to payment page

Asian-American	Black/African-American	Latino/Latina	Native American
Other Hispanic American	White or Caucasian	Puerto Rican	Other

Colleague	Internet Search	Friend	Family	Social Media
None of the above