Student Application for Child Welfare Stipend

Thank you for your interest in the Title IV-E Stipend Program! Please fill out the information below. Narrative instructions and other application requirements are included in this form. Fall 2026 application will be due 4/15/26 by 5 pm.

Date Date / MM / DD YYYY
What semester and year are you applying for?
Personal Information
Name Name First Last
Middle Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Tx. Driver’s Lic #
Student ID
Student Email
Personal Email
Date of Birth Date of Birth / MM / DD YYYY
Cell Phone Cell Phone - ### - ### ####
I am interested in working in:

I am interested in working in: Dallas Tarrant Outlying Counties Other Other
Ethnicity

Ethnicity White/Caucasian Black/African American Asian Native Hawaiian/ Pacific Islander Native American/Alaskan Native Hispanic/Latino Other Other
Gender

Gender Female Male
U.S. Citizen

U.S. Citizen Yes No
Bilingual

Bilingual Yes No Language Language
Education Information

Please list all relevant educational information.
Are you a Graduate Student?

Are you a Graduate Student? Yes No

If you are not a graduate student, please skip the following two questions.
Undergraduate Degree
Type of placement

Type of placement BSW Practicum Advanced MSW Practicum
Are you an Undergraduate Student?

Are you an Undergraduate Student? Yes No
Type of Internship

Type of Internship Block
Current Overall GPA
Program Information
Do you have your own transportation?

Do you have your own transportation? Yes No
Is your transportation reliable?

Is your transportation reliable? Yes No
Do you have any relatives working for UTA and/or in child welfare (CPS or CBC)?

Do you have any relatives working for UTA and/or in child welfare (CPS or CBC)? Yes No
If yes, please indicate department/office and date of hire below:
Have you ever been investigated by the Texas Department of Family & Protective Services (CPS, APS, CCL included)? (or in any other state?)

Have you ever been investigated by the Texas Department of Family & Protective Services (CPS, APS, CCL included)? (or in any other state?) Yes No
Have you ever had any criminal convictions?

Have you ever had any criminal convictions? Yes No
If yes, please explain
Are you willing to apply for and accept employment, if offered, with the agency you are placed?

Are you willing to apply for and accept employment, if offered, with the agency you are placed? Yes No
Narrative Information

INSTRUCTIONS: Please compose one paragraph for each of the following items and upload your file once completed.

1. Describe your understanding of OR experience with the Child Welfare system.
2. Explain why you are interested in working in the Child Welfare system.
3. Many clients who utilize the services of Child Welfare programs are affected by poverty, mental illness, IDD, substance abuse, etc. In what ways are you prepared to interact with these factors?
4. What contribution do you feel you can make to the field of Child Welfare?
5. Describe your beliefs as to what are (is) the most powerful force in a child’s life.
Narrative Upload

Attach Files
Faculty Reference

For this portion of the application process, only one reference is required. If your professor plans to send this separately, please let us know. This reference should speak to your academic performance.
Will this be sent separately?

Will this be sent separately? Yes No
Faculty Reference Upload

Attach Files
Resume

Please upload your most up-to-date resume
Resume Upload

Attach Files
COMMENTS: include any additional information you feel should be considered.

Student Application for Child Welfare Stipend

Personal Information

Education Information

Program Information

Narrative Information

Faculty Reference

Resume