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Case Summary Face Sheet

The case submitted should include a detailed face sheet, disguised identifying data and process recordings.

Please refer to the detailed guidelines (PDF) for the submission of a case.

*Indicates a required field

Applicant's Information

First:*
Middle:
Last:*
Current e-mail address:*
MSW degree granting college (for identification purposes):*
Client:
Theory used:

Therapist Information

Age:
Gender:
Race/ethnicity:
Place of birth:
Primary language:
Social class:
Religious background:

Client's Information

Age:
Gender:*
Race/ethnicity:*
Place of birth:
Primary language:
Social class:
Religious background:

If client is adolescent:

Describe siblings, caregivers, and others living in the home:
Upon whom does the child depend?

If client is a teen parent:

Number of children, their first names, year of birth, and school grade or occupation:

If client is an adult:

Current partnership/marital status:
Previous separations or divorces:
Children, their first names, year of birth and school grade or occupation:
Parents/grandparents national background:

More Information

Client residence (describe dwelling):
Client education (if child, grade in school and kind of school):
Client occupation (if applicable):
Client income (monthly):
Income source:
Number of people income has to support:
Agency fee:



Upload Case Summary

Please upload your case summary here (Microsoft Word or PDF formats only). Please do not use quotes in the document name. Maximum file size: 25 MB. If you need to submit a larger file, please email it to sswapp@smith.edu.

Important Note: If accepted, the case material you provide will be used in your first year practice class.

If you are unable to use this form, e-mail us at the Smith College School for Social Work Office of Admisson, or call us at (413) 585-7960.