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:

  1. Accepted standards of professional conduct,
  2. standards of personal integrity and honesty,
  3. emotional stability requisite for professional practice,
  4. effective interpersonal skills necessary for forming professional helping relationships with clients, supervisors, faculty, and colleagues, and
  5. 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.
  6. Severe maladaptation to the educational process for the social work profession including:

2021-2022 KSU UNDERGRADUATE CATALOG