ࡱ> #` objbj <G  8,!"\ )<*IIII\I`-w$6zh|Qw ;F'J';;Qw %%hwN@N@N@; 8% %HN@;IN@N@rCT  oD%d" `m  B=H/DG< x0`6}oDoD6} iF(d+F0N@n4r7d+d+d+QwQw?dd+d+d+*CJOJQJUaJh?rCJOJQJaJhc9MhCJOJQJaJ3jhh?r>*CJOJQJUaJmHnHu.jhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhc9MhGWCJOJQJaJ'hc9Mh5CJOJQJaJmH sH *hc9MhO*CJOJQJUaJhh?r>*CJOJQJaJhc9MhwCJOJQJaJhc9Mh]CJOJQJaJhc9MhO*CJOJQJUaJmHnHu(jhh?r>*CJOJQJUaJ   " 6 8 : D F H J V X l n ʵsֵ[sֵC.j-hh?r>*CJOJQJUaJ.jhh?r>*CJOJQJUaJ3jhh?r>*CJOJQJUaJmHnHu.jAhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhCJOJQJaJhc9MhGWCJOJQJaJh?rCJOJQJaJhc9MhCJOJQJaJn p z |  ³£{cK.jhh?r>*CJOJQJUaJ.jhh?r>*CJOJQJUaJ.jhh?r>*CJOJQJUaJhh?r>*CJOJQJaJhhNN>*CJOJQJaJhc9MhwCJOJQJaJhc9Mh]CJOJQJaJ3jhh?r>*CJOJQJUaJmHnHu(jhh?r>*CJOJQJUaJ 246@BDFHlphp^L<-hc9MhO*CJOJQJUaJmHnHu.jhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhc9MhwCJOJQJaJhc9Mh]CJOJQJaJh?rCJOJQJaJh֦허ydT*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhc9MhwCJOJQJaJhc9MhCJOJQJaJhc9MhO*CJOJQJaJmH sH 3j{hc9MhO*CJOJQJUaJhh?r>*CJOJQJaJhc9MhCJOJQJaJhc9MhCJOJQJaJhCJOJQJaJ(jhh?r>*CJOJQJUaJ3jhh?r>*CJOJQJUaJmHnHu "68:DFHLVZ\prt~뚎v뚎^뚎.j2hh>*CJOJQJUaJ.jhh>*CJOJQJUaJhCJOJQJaJhc9MhCJOJQJaJ3jhh>*CJOJQJUaJmHnHu.jFhh>*CJOJQJUaJhh>*CJOJQJaJ(jhh>*CJOJQJUaJ  ",.02FHJTVXZnpr|~ӹӪӚӹӚӚjӹӚӚRӹӪ.j hh>*CJOJQJUaJ.j hh>*CJOJQJUaJ.j hh>*CJOJQJUaJhh>*CJOJQJaJhc9MhCJOJQJaJ3jhh>*CJOJQJUaJmHnHu(jhh>*CJOJQJUaJ.jhh>*CJOJQJUaJ :<0246rpr.02*$gdOZ\Ўp^pNB,+j h?rh?rCJOJQJUaJh?rCJOJQJaJjh?rCJOJQJUaJ"hc9MhR56CJOJQJaJhc9MhRCJOJQJaJhc9MhCJOJQJaJ3jhh>*CJOJQJUaJmHnHu.j hh>*CJOJQJUaJhh>*CJOJQJaJ(jhh>*CJOJQJUaJhc9MhCJOJQJaJhCJOJQJaJ\^026nprͻ{fV>f$3jhh?r>*CJOJQJUaJmHnHu.jl hh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhc9MhCJOJQJaJhc9MhO*CJOJQJaJ.jX hh?r>*CJOJQJUaJhc9MhCCJOJQJaJ3jhh?r>*CJOJQJUaJmHnHu.j hh?r>*CJOJQJUaJhh?r>*CJOJQJaJhc9MhCJOJQJaJhc9Mh?rCJOJQJaJhRCJOJQJaJ(jhh?r>*CJOJQJUaJ *,.2íѕчsfR<ѕ*jD hh?r>*OJQJUaJ&hc9Mh-(5OJQJ\aJmH sH hhO*OJQJaJ/jhh?r>*OJQJUaJmHnHu*j hh?r>*OJQJUaJhh?r>*OJQJaJ$jhh?r>*OJQJUaJhOJQJaJ!hC5CJOJQJaJmH sH lnbd24x  $*$If $*$If ! h$If *$gd *$  *$gdv*$gdC*$gdO2hCJOJQJaJ*hc9Mhv5CJOJQJ\aJmH sH $h?r5CJOJQJ\aJmH sH /jhh?r>*OJQJUaJmHnHu*j hh?r>*OJQJUaJhh?r>*OJQJaJ$jhh?r>*OJQJUaJhc9MhCOJQJaJ"hc9MhO*OJQJaJdfz|~:Sq떇qaO@1@1@1@hc9Mh]CJOJQJaJhc9MhCJOJQJaJ"hh5CJOJQJ\aJhc9Mh6CJOJQJaJ*hc9Mh56CJOJQJaJmH sH h5CJOJQJ\aJ%hh5>*CJOJQJ\aJ3jhh?r>*CJOJQJUaJmHnHu.j0hh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJxz   "$оvcU?c*jhh?r>*OJQJUaJhh?r>*OJQJaJ$jhh?r>*OJQJUaJhOJQJaJhc9MhOJQJaJhc9Mh5CJOJQJaJhc9MhCJOJQJaJ"hc9Mh]56CJOJQJaJ"hc9Mh56CJOJQJaJ"hc9Mh56CJOJQJaJhc9MhCJOJQJaJhc9Mh]CJOJQJaJ$.024NPRfhjtvxzǸԐzǸԐdǸԐN*jhh?r>*OJQJUaJ*jhh?r>*OJQJUaJ*jhh?r>*OJQJUaJhh?r>*OJQJaJhc9MhwOJQJaJhc9MhOJQJaJhc9MhCJOJQJaJhc9MhOJQJaJ$jhh?r>*OJQJUaJ/jhh?r>*OJQJUaJmHnHuxz{o  $*$If $*$If ! h$Iflkd$$Ifl0*04 la*DǸwawK<hc9MhCCJOJQJaJ+jh?rh?rCJOJQJUaJ+jh?rh?rCJOJQJUaJh?rCJOJQJaJjh?rCJOJQJUaJ*hc9Mh56CJOJQJaJmH sH hc9MhCJOJQJaJhc9MhCJOJQJaJhc9MhOJQJaJ$jhh?r>*OJQJUaJ/jhh?r>*OJQJUaJmHnHu*ln^` ~wwww *$  *$gd *$gdlkd$$Ifl0*04 la DFZ\^hjln.02:<XZ\^`뚋{oY{{oC{6hc9MhOJQJaJ+j^h?rh?rCJOJQJUaJ+jh?rh?rCJOJQJUaJh?rCJOJQJaJjh?rCJOJQJUaJhc9MhCCJOJQJaJhc9MhCJOJQJaJ3jhh?r>*CJOJQJUaJmHnHu.jrhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJ`4 8 9 G H I M N \ ] ^ ` տթՄn_Phc9MhCJOJQJaJhc9MhRCJOJQJaJ+j6h?rh?rCJOJQJUaJ+jh?rh?rCJOJQJUaJhc9MhCJOJQJaJ+jJh?rh?rCJOJQJUaJ+jh?rh?rCJOJQJUaJh?rCJOJQJaJjh?rCJOJQJUaJhc9Mh]CJOJQJaJ ! ! ! ! !!!!!" " ""پʙxhPx6x3jhh?r>*CJOJQJUaJmHnHu.jhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhCJOJQJaJhc9MhCCJOJQJaJ+j"h?rh?rCJOJQJUaJh?rCJOJQJaJhc9MhCJOJQJaJjh?rCJOJQJUaJ+jh?rh?rCJOJQJUaJ !!""\^^^^^```cccc@ddeee$a$gd^M!$a$gd^M!$a$gdT $*$a$gdT 0*$gd?r *$gd?r*$gd^M *$ *$gd consider when making geographic assignments.  FORMTEXT       Are you aware of any potential conflict of interest that you might have with any of our affiliated training sites, particularly regarding previous treatment experiences and/or employment of self, family or significant others? If so, please identify the agency name here:  FORMTEXT       Do you have any physical condition or other documented medical or learning needs you wish us to take into account in selecting a field placement setting? (Your answer to this question is optional, but it should be understood that the School cannot be held responsible for special needs unless those needs have been identified prior to the placement process.)  FORMTEXT       Geographic Distribution Of Affiliated Training Centers (As planning for the 09-10 affiliation roster is still in process, applicants are encouraged to contact the Admission Office after Dec. 1 for updated information.) Canada (Toronto) (For Canadian citizens only) Northern California (Bay Area) Southern California (Los Angeles Area) Colorado (Denver, Boulder) Connecticut (Danbury, Hartford, New Haven) Georgia (Atlanta Area) Illinois (Chicago Area) Maine (Portland, Augusta) Eastern Massachusetts Central & Western Massachusetts New Hampshire (Portsmouth, Lebanon area) New Mexico (Albuquerque) New York City Area (includes Westchester County) New York State (Albany and Poughkeepsie*) North Carolina (Durham) Ohio (Cleveland, Cincinnati) Pennsylvania (Philadelphia) Rhode Island (Providence) Texas (Houston and San Antonio) Vermont (Brattleboro, White River Junction, Burlington) Virginia (Charlottesville)* Washington, DC Area (includes Baltimore, MD, Northern VA) Washington State (Seattle) *This area ordinarily has placements only for second year or advanced standing students.   FIELD PLACEMENT FORM Smith College School for Social Work ( Lilly Hall ( Northampton, MA 01063 Office of Admission (413) 585-7960  HYPERLINK "mailto:sswadm@email.smith.edu" sswadm@email.smith.eduOffice of Financial Aid (413) 585-7986  HYPERLINK "mailto:sswfa@email.smith.edu" sswfa@email.smith.eduOffice of Field Work (413) 585-7965  HYPERLINK "mailto:sswfield@email.smith.edu" sswfield@email.smith.edu  "$^\^^^`^t^v^x^^^^`````ξΌ|r`S;`.jh^Mh^M>*CJOJQJUaJh^M>*CJOJQJaJ"jh^M>*CJOJQJUaJh^MOJQJaJhhC>*CJOJQJaJ3jhh?r>*CJOJQJUaJmHnHu.jhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhCJOJQJaJUhc9MhCJOJQJaJ`````araccccccccccɽo_Go-o_3jhh?r>*CJOJQJUaJmHnHu.jhh?r>*CJOJQJUaJhh?r>*CJOJQJaJ(jhh?r>*CJOJQJUaJhCJOJQJaJhc9MhRCJOJQJaJhc9MhCJOJQJaJhc9MhCJOJQJaJh^MCJOJQJaJh?r>*CJOJQJaJ"jh^M>*CJOJQJUaJ-jh^M>*CJOJQJUaJmHnHuccc@dBdeeeeeeggDhNh|jjkkűşxbxRxRxRxBht8CJOJQJaJmH sH h^MCJOJQJaJmH sH *hc9Mh^M6CJOJQJ]aJmH sH $hc9Mh^MCJOJQJaJmH sH 'hc9Mh^MCJOJQJ\aJmH sH #hc9Mh^MCJOJQJ\mH sH 'hZ4IhTOJPJQJaJhnHtH#hZ4IhTOJQJ\aJmH sH &hZ4IhT5:OJQJaJmH sH hc9MhaJh?rCJOJQJaJee(fvffg0g`ggghRhhh:ijiiijPjjjlkkkkXl\l$a$gdt8 $dha$gd^MkkVlXlZl^l`ldlflhljlnlpltllllllll$m&m\mmkRkRk?%hc9Mhc9MB*CJOJQJaJph1 jhc9Mhc9M5;B*CJOJQJaJph+hc9Mhc9M5;B*CJOJQJaJph%hc9M5;B*CJOJQJaJphhkcIhc9M*hhc9M5CJOJQJ\aJmH sH h?CJjh?Uh?jh?CJUhc9Mh):CJOJQJaJhc9Mht8OJQJmH sH $hc9Mh-(CJOJQJaJmH sH \l^lbldlflhlllnlrltllllll $$Ifa$gdc9M% $ *$a$gdc9Mdll\m^m`mp+Dkd$$IfTl$h% t644 laT$IfgdkcIl''$$Ifa$gdkcIl''fkdp$$IfTld ( +064 lalT`mmm2nbnno2oPooooooo~|zzz&jkd$$IfTlF $x x x t6    44 laT$$Ifa$gdkcIl'mmmnn.n0nnnnnnooPoRoooooooooooooպՊokgc_[Khc9Mh):CJOJQJaJh+Ghlugh?hkcIhc9M4j6hc9Mhc9MB*CJOJQJUaJph4j[hc9Mhc9MB*CJOJQJUaJph)hc9Mhc9M0J$B*CJOJQJaJph4j|hc9Mhc9MB*CJOJQJUaJph%hc9Mhc9MB*CJOJQJaJph.jhc9Mhc9MB*CJOJQJUaJphooo$a$gdt8:....()()))()()00P8$:pCBP/ =!"#$X% DyK sswapp@email.smith.eduyK <mailto:sswapp@email.smith.eduvDText22vDText23vDText24vDText25vDText26vDText27vDText28vDText29vDText30vDText31DyK sswadm@email.smith.eduyK <mailto:sswadm@email.smith.eduvDText32vDText33vDText24vDText25vDText26vDText27vDText28vDText29vDText30vDText31vDeCheck11vDText34vDText35vDText36vDText37vDText38vDText39vDText40vDText41vDText42$$If!vh55#v:V l054vDText43vDText44$$If!vh55#v:V l054vDeCheck12vDeCheck13vDText45vDeCheck14vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20vDeCheck21vDText46vDText47vDText49vDText48$$Ifl!vh5 +#v +:V ld065 +4alT~$$If!vh5h%#vh%:V'l t065h%TDyK sswadm@email.smith.eduyK <mailto:sswadm@email.smith.eduDyK sswfa@email.smith.eduyK :mailto:sswfa@email.smith.eduDyK sswfield@email.smith.eduyK @mailto:sswfield@email.smith.edu$$If!vh5x 5x 5x #vx :V'l t065x T)H@H Normal1$OJQJ_HhmH sH tH XX Heading 1$$ *$@&a$5>*CJOJQJLL Heading 2$*$@&  CJOJQJDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 8+@8  Endnote TextCJ>*> Endnote ReferenceH*::  Footnote TextCJ@&!@ Footnote ReferenceH*NN TOC 1) $ 0*$]^`0JJ TOC 2% $ 0*$]^`0JJ TOC 3% $ p0*$]^p`0JJ TOC 4% $ @ 0*$]^@ `0JJ TOC 5% $ 0*$]^`0BB TOC 6 $0*$^`0:: TOC 70*$^`0BB TOC 8 $0*$^`0BB TOC 9 $ 0*$^`0N N Index 1% $ `*$]^``N N Index 2% $ 0*$]^`0>.>  TOA Heading *$ $.". CaptionCJ:: _Equation CaptionFB@F Body Text !*$ h CJOJQJdC"d Body Text Indent" hh*$^h` CJOJQJH2H D Balloon Text#CJOJQJ^JaJ6U@A6 O*B*ph4@R4 c9MHeader % !4 @b4 c9MFooter & !n@sn c9M Table Grid7:V'0'PJzOz vtemplacecdebodycopylessspace(dd1$[$\$CJOJQJaJh%OP9:;K"#%8  w]^_p 8 9 6 7 K L M   < = ^ _ 67 ()IJ^_o;/VqD] #C{GIJLMNOQRTUjklmno4L[00000(0000000000000000000000000000000000000000000000000000000000!00 0 0 !00 0 0 0000000000000000000000000000!0!0!00000000000000000000000000000 00000000000000000000@0@%00 0@0@0 @0 @0@0 @0 @0@0@0 @0@0@0 @0@0@0 @0 @&00000P00\0;@0@0@0 00 %% b n h \d$D` "`ckmo !"$%&')+,-89:<@ x e\ll`moo#(*.;=>?Ao[ %17Uagr~ FRXbnt$*,8>IU[.   # / 5 7 C I    ( 4 : J V \ m y  ".48HM]  JV\o{XFFFFFFFFFFXFFFFFFFFFFG FFFFFFFFFFFG G FG G G G G G G G FFFF@V|XXXt  ,2$qi޷sV#@ 0(   B S  ?H0(  'Text22Text23Text24Text25Text26Text27Text28Text29Text30Text31Text32Text33Check11Text34Text35Text36Text37Text38Text39Text40Text41Text42Text43Text44Check12Check13Text45Check14Check15Check16Check17Check18Check19Check20Check21Text46Text47Text49Text48&VsGc $ 8  ) K n #9NKo  !"#$%&8h!Yu/ 6 J  ; ] 5I^ !]`he h[K hh[K h|h\K hhh< hĢP  h h[K  h h|hP hP hDP hDP hP hP hP hTP hĠP hDP h h h h hL h h h  hL !h "h- #h4- $ht- %h- &h- 'h4- (ht- )h- *h- +h4- ,ht- -h\.h/h0h1h\2h3h4h5h\6h7h8hsL 9htL :hDtL ;htL hDuL ?huL @huL AhvL BhDvL ChvL Dh{ Eh{ FhD{ Gh{ Hh{ Ih{ JhD{ Kh{ Lh{ Mh{ NhD{ Oh{ Ph{ QhD RhD Sh D ThLD UhD VhD Wh D XhLD YhD ZhD [h D \hLD ]hD ^h|D _hD 88EH<<BDDV`hhq~  **6DPPzz #*66CLoo{ou}      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\^]_ CGMMAII#OO^foo|(4==N[[!!(1AAJWyyt|   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\^]_BS*urn:schemas-microsoft-com:office:smarttagscountry-region>W*urn:schemas-microsoft-com:office:smarttags PostalCode9X*urn:schemas-microsoft-com:office:smarttagsState8Y*urn:schemas-microsoft-com:office:smarttagsCity9`*urn:schemas-microsoft-com:office:smarttagsplace=_*urn:schemas-microsoft-com:office:smarttags PlaceName=^*urn:schemas-microsoft-com:office:smarttags PlaceType 7`_^^_^`YXW_`^SY``Y`XYY`XYYY`SY`XY`XYY``X`XY`SXY`_`^_^YY`XY`XYY`XY`XY`XYY`XYY`XY`YXYX`_^Y`_^^Y`XW%'MP/9 6 M 8IM^ oFGGIIJJLMNOQRTUj'-/ 8IM^ "'oGGIIJJLMNOQRTU333333/ 8IM^ oGGIIJJLMNOPQRSTUjGGIIJJLMNOQRTUD( oQEf_"s7I T hh^h`o(.h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH.hh^h`o(.hh^h`o(.D(T7IoQE          gZ 6E [     j i k k m m \\SMITH_TREE\sswlilly108qC odXXLetter DINU"L$SMTJHP LaserJet 2300 Series PCL 6InputBinFORMSOURCERESDLLUniresDLLResolution600dpiFastResTrueOrientationPORTRAITHPOrientRotate180FalseCollateOFFEconomodeFalseTTAsBitmapsSettingTTModeOutlineRETChoiceTrueHPStraightPaperPathFalseHPPrintOnBothSidesManuallyFalseHPManualDuplexDialogItemsInstructionID_01_NPPHPManualFeedOrientationFACEDOWNHPOutputBinOrientationFACEDOWNHPManualDuplexDialogModelModelessHPManualDuplexPageOrderEvenPagesFirstHPMapManualFeedToTray1TrueJRHDNotInstalledJRHDOffPrintQualityGroupPQGroup_3HPLpiSelectionNoneJRConstraintsJRCHDPartialJRCmdCallbackJRHPColorModeMONOCHROME_MODEHPPDLTypePDL_PCL6HPPJLEncodingUTF8HPJobAccountingHPJOBACCT_JOBACNTHPBornOnDateHPBODHPJobByJobOverrideJBJOHPPCL6PassThroughTrueHPFontInstallerTRUEDuplexNONEPaperSizeLETTERHPPaperSizeDuplexConstraints16KMediaTypeAutoHPXMLFileUsedHPXMLFileNameIUPHdLetter [none] [none]Arial4Pd?SMITH<Automatic>     j i k k m m  3:   @@@ @@@@@@4@@@@@@@"@^UnknownGz Times New Roman5Symbol3& z ArialWSimSunArial Unicode MS;Wingdings?5 : Courier New9CG Times5& zaTahoma")HffD[F , ,!)Pd;;2Q)PHP ?T2FOR OFFICE USE ONLY  EC [ ] Smith College Smith College    Oh+'0 ,8 X d p | FOR OFFICE USE ONLY EC [ ]Smith CollegeField_Placement_Form.dotSmith College2Microsoft Office Word@G@J@  @  ՜.+,D՜.+,T hp  Smith College, ; FOR OFFICE USE ONLY EC [ ] Title 8@ _PID_HLINKSA8J;!mailto:sswadm@email.smith.edu&W/mailto:sswapp@email.smith.edu&!Z mailto:sswfield@email.smith.edu&f mailto:sswfa@email.smith.edu&J;mailto:sswadm@email.smith.edu&  !"#$%&'()*+,-./0123456789:;<=>?@ABDEFGHIJKLMNOPQSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F@~ Data C1TableRR}WordDocument<SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q