Viterbo University - The University of Opportunity: Hope and Help 

Social Work Program Admission Application


Application deadline is February 1st   

If you have questions contact Debra Daehn Zellmer, Murphy Center 521, phone: 608-796-3728, email: 

IMPORTANT: Information on this form will not be saved, allow one hour to thoroughly complete this application form.

PART I: Descriptive Information


Last name   First name  Middle initial   

Current mailing address 

Address   City    State    Zip  

Contact phone with area code   Cell phone with area code  

Viterbo email       Student's Viterbo ID#

Other principle email (if not a current Viterbo student)   

Summer mailing address if different from above.
 Address   City  State  Zip  

PART II: Minimum Admission Requirements  


Are you currently a Viterbo student?   Click on arrow to select Yes or No   

Total credits completed to date     

What is your cumulative GPA?     

At what college did you take Introduction to Social Work?     

Indicate your grades in the following fields or specify if you are enrolled in Spring Semester.





If not completed are you enrolled for Spring Semester.

If not enrolled, list semester and year you plan on taking this course.   

BIOL 203 Human Biology for the Social Sciences      
ENGL 103 Composition & the Elements of Argument      
ENGL 104 Composition & Literature      
POSC 121 Introduction to American Government      
PSYC 100 or 171 Effective Behavior or General Psychology      
SOCL 125 Introduction to Sociology      
SOWK 210 Introduction to Social Work      
SOWK 240 Introduction to Research Process and Analytical Writing      
SOWK 275 Social Work through Service Learning      

PART III: Conditional Admission


A student who does not meet all the minimum admission requirements listed in Part II and outlined in the Admissions Policy and Procedure, may be considered for conditional admission. 

Are you requesting consideration for conditional admission?  

Identify all areas that you are requesting special consideration: 

I have been admitted to Viterbo University     If no, list your proposed entrance date    

I have completed at least 36 semester hours   If no, provide a rationale for admission now     

My cumulative GPA meets the 2.5/4.0 minimum       If no, provide a rationale for admission now   

I will have all prerequisite courses completed by the end of Spring Semester      If no, what is your plan to complete these prerequisites? 


PART IV: Self Disclosure Statements


Are you a transfer student?     Transfer students who have not completed at least 12 credits from Viterbo University must provide documentation of transfer course grades and GPA (transcript or Viterbo University Evaluation of Transfer Credits).

 When do you anticipate graduating from Viterbo?  Select Month and Year:  

   Have you ever been suspended, expelled, placed on probation, or otherwise disciplined by any college or university or from any program of a college or university other than for academic reasons?
If yes, explain 


   Have you ever been admitted to, then withdrawn from or been asked to withdraw from another accredited social work program? 

If yes, explain

Criminal Background Policy 

While having a criminal background does not preclude acceptance into the social work program, applicants need to be aware that certain criminal offenses may bar an individual from being credentialed as a social worker upon graduation. Check the website for the Wisconsin Department of Health and Family Services at for further information about the Caregiver Background and Criminal History Check. Students with a history of physical violence, sexual misconduct or any other offense which would make the student unemployable as a social worker may be denied admission into program or field education. A Caregiver Background and Criminal History Check will be completed on all students prior to being placed in an agency for SOWK 480 Field Education. The results of this background check may have an impact on your ability to secure a field education placement. Applicants are required to disclose any criminal charges or record so that we can engage the applicant in a discussion regarding the potential ramifications of their criminal record for successful advancement in the social work program and social work certification.

   Have you ever been charged with, convicted of, pled guilty or, no contest to, or forfeited bail for any criminal conduct under law or ordinance, excluding only minor traffic violations?

If yes, explain

   Do you have a history of AODA - alcohol or drug dependency or addiction?

If yes, explain


PART V: Affirmative Action (Optional)


Viterbo University is committed to providing equal educational and employment opportunities regardless of age, race, religion, color, handicap, sex, physical condition, developmental disability, sexual orientation, or national origin in compliance with Title VI, Title IX, and Section 504.

  I would like information on accommodation based on disability related needs.

You are under no obligation to reveal your sex, marital status, citizenship, race, religion, date of birth or disability status. However, we are interested in obtaining a profile of our applicants for affirmative action purposes. This information is not used in the admissions process. 

Birth (month/day/year)
Race/Ethnic Identification
Do you have a documented disability?    
Are you a U.S. Citizen, Yes or No? 
If no, list other 


PART VI:  Example of Academic Writing


Provide us with an example of your best college writing. This should be academic writing incorporating resources, in text citations (either MLA or APA) and a reference page. This could be your final paper for Introduction to Social Work or a paper you have completed for some other course. Markings from an instructor on this paper are acceptable but not necessary.

Submit Example of Academic Writing Paper as an attachment to: SOWK Application or, as a hardcopy to: Penny Blank in Murphy Center 538.


PART VII: Personal Statement


As part of your application for admission to the Social Work Program, write a statement which addresses the areas listed below. This statement will be used to assess your writing skills and to aid the admissions committee in making a decision about your application for admission. Your statement, should be 3–5 double spaced pages in length. We ask that you do not receive assistance on your writing of this essay from a writing specialist. If you have a diagnosed disability, contact Deb Daehn Zellmer, Social Work Program Director to determine appropriate accommodations. Organize your written statement by addressing the following areas:

  1. What are the influences in your family, school, and community that have been important in your decision to become a social worker?
  2. Describe the way your personal values and beliefs are consistent with those of the profession as reflected in the Social Work Code of Ethics.
  3. Evaluate your personal strengths and areas for growth in relation to:  your concern for social problems; your attitudes toward people who are different; your ability to cope with stressful situations and think clearly under pressure; and your ability to work with others.
  4. In what way(s) has Introduction to Social Work changed the way in which you view yourself, the world, and the profession of social work?
  5. Reflect on your service learning experience, describing how it assisted you to select social work as a profession.
  6. Is there anything else you feel might be useful to the social work program in making its decision?

Submit Personal Statement as an attachment to: SOWK Application or, as a hardcopy to: Penny Blank in Murphy Center 538.


If you are interested in saving a copy for your personal records follow these steps before clicking on the Submit Form button below: Select All, Copy, Paste into a Word document, Save As, Name, then designate location for file. 

To submit completed form click on the Submit Form button below which will send your online Application for Admission form to email account:  SOWK Application.