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Clinical Forms
Required Paperwork to begin Practicum / Internship experience (April1 deadline for starting Practicum in the Fall semester and December 1 deadline for starting Practicum in Spring semester)
Clinical Site Approval Request Form - Clinical Mental Health Counseling
Clinical Site Approval Request Form - Community Counseling
Clinical Site Approval Request Form - Marriage, Couple, & Family Counseling & Therapy
Clinical Site Approval Request Form - School Counseling
Clinical Site Approval Request Form - Substance Awareness Coordinator
Consent for Video- / Audio-taping
Permission to Audio-Videotape Consent Form for Use in Individual Supervision
Permission to Audio-Videotape Consent Form for Use in Individual and Clinical Team Supervision
Practicum and Internship Activity Logs
Practicum Activity Log: Excel version
Internship Activity Log: Excel version
Practicum Activity Log for MCFCT students: Pdf
Internship Activity Log for MCFCT students: Pdf
Supervision Form and Evaluations
100 Hour Evaluations
Practicum Evaluation of Counselor - On Campus Individual Supervisor
Practicum Evaluation of Counselor - Site Supervisor
End of Semester Evaluations (for On Campus and On Site Supervisor)
Supervisor's Evaluation of Counselor-Clinical Mental Health Counseling
Supervisor's Evaluation of Counselor-Community Counseling
Supervisor's Evaluation of Counselor-Marriage, Couple & Family Counseling & Therapy
Supervisor's Evaluation of Counselor-School Counseling
Weekly Supervision Session Log (for On Campus and On Site Supervision)
Student Evaluation of Supervisor
Guidelines for K-12 Comparative Analysis or Agency-Organizational Analysis
Agency-Organizational Analysis
Internship Conclusion Evaluations
Student Evaluation of Clinical Site
Evaluation of Clinical Program by Site Supervisor
Requirement of Professional Liability Insurance
Students who plan on starting Practicum in the Spring 2011 or afterwards are required to obtain their own professional liability insurance in addition to the coverage provided through the College and/or his/her placement. A copy of the student’s certificate of insurance needs to be submitted to his/her Practicum or Internship course instructor at the beginning of the semester and when the student renews his/her professional liability insurance. While the Department requires students to purchase professional liability insurance to adhere to the best practice, it should be noted that it is a rare occurrence that would require the protection provided by professional liability insurance.
The Department suggests membership in American Counseling Association (ACA) and enrollment in the professional liability insurance plan that is available to all ACA graduate student members. For the students in School Counseling Program, American School Counselor Association (ASCA, a division of ACA) also offers the professional liability insurance plan. Similarly, the students in Marriage, Couple and Family Counseling and Therapy Program may obtain a professional liability insurance through membership in American Association for Marriage and Family Therapy (AAMFT). Each student will need to evaluate the clinical site to determine which professional liability insurance is appropriate. Student membership benefits for ACA, ASCA, or AAMFT can be found in its respective website, counseling.org, schoolcounselor.org, or aamft.org.
