KENTUCKY STATE UNIVERSITY
Student Signature: ___ Date: ___
Faculty Signature: _____ Date: _____
BSW Director Signature (as applicable): ___ Date: ___
Chair Signature: Date:
Agency Supervisor/Field Director Signature: (as applicable): Date: ___ ___
Plan Review
Date and Time of Review Meeting:___
Has the student resolved all performance issues to the supervisor's and/or faculty members' satisfaction? Yes No
If not, what is the requested resolution of the situation?
Creation of a New Success Plan
Creation of a Self-Care Plan
Dismissal of Student from their Practicum Placement with the Agency
Assignment of grade on a paper, examination, or other material related to the offense
Assignment of grade on a paper, examination, or other material related to the offense
Assignment of grade for the course in which the offense occurred
Dismissal of Student from the School of Social Work
___ Other (please, explain)___
Student Signature:Date:
Faculty Signature:Date:
BSW/Field Director/Chair Signature:Date:
Agency Supervisor (as applicable):Date:
Bases for Possible Dismissal from BSW Program
Failure to meet the expectations set forth in the NASW Code of Ethics is grounds for dismissal from the program, including deviation from:
Accepted standards of professional conduct,
standards of personal integrity and honesty,
emotional stability requisite for professional practice,
effective interpersonal skills necessary for forming professional helping relationships with clients, supervisors, faculty, and colleagues, and
appropriate or productive professional behaviors, attitudes, and values, whether demonstrated at school, in the field practicum setting, or in one's employment setting, or other roles.
Severe maladaptation to the educational process for the social work profession including:
2021-2022 KSU UNDERGRADUATE CATALOG