Viterbo University - The University of Opportunity: Hope and Help 

Applicant Signature Form


PART  VIII :  Applicant Signature

  I hereby apply for admission to the Viterbo University Social Work Professional Program. I have read all of the information pertaining to this process, understand it, and believe that I meet the qualification as presented in this application. I understand that meeting minimum admission requirements does not guarantee admission to the Social Work Professional Program.
  I understand that a Caregiver Background Check will be conducted at the time that I am applying for field education placement and that the results of this background may impact my ability to secure a field education placement. Furthermore, I agree to notify my academic advisor or the Social Work Program Director within 24 hours of any criminal charges that I encounter while enrolled in the professional phase of the Social Work Program.
  I understand that falsification or omission of information relevant to this application may constitute grounds for denying me admission or terminating my admission if falsification or omission is discovered. I agree to inform the Program Director if circumstances occur which would change my responses. I give my permission to the Social Work Program to maintain application materials as part of a file for the program to use for my educational purposes.
  I also recognize that an affirmative response to the Self Disclosure Statements section  of this application process will be considered only as it substantially relates to the duties and responsibilities of professional social work practice. I understand that additional information may be requested with my consent if necessary.

I understand as a social work student, I am expected to adhere to the values, ethics and standards of the profession of Social Work as stated in the NASW Code of Ethics. I will practice using the Code of Ethics and follow the Viterbo University Social Work Program's Student Code of Conduct.


Printed Signature:    

  • If you are interested in saving a copy for your records. Select File, Save As, Name, then designate location for file.
  • If you would like to print a copy. Select File, Print.