Practicum and Internship forms (Master's level)


For students starting the program prior to 2011.

Site Summary Forms

Site Summary Form (Counseling) Word Document PDF Document
Site Summary Form (Marriage & Family) Word Document PDF Document
Site Summary Form (Counseling Psychology) Word Document PDF Document
Site Summary Form (Internship) Word Document  



Practicum (PDF files)

Guidelines for Practicum in Counseling I & II
Guidelines for Practicum in Marriage and Family Therapy
Guidelines for Practicum in Counseling Psychology I & II


Guidelines for Internship

Students beginning their program Fall 2011 and after are under new requirements and guidelines.  It is important that the student is aware of his/her program of study and exactly which practicum/internship courses are to be taken.   Students taking the one semester of practicum/three semesters of internship must go through an application process.  Below are the deadlines for submission of the completed application packet.

Guidelines for Practicum and Internship (PDF)

Forms for Practicum

     Application Packet Deadlines for Practicum

     Summer Semester  March 1
     Fall Semester  July  1
     Spring Semester  November 1

     Download the Application form below for instructions.   All forms are to be completed, signed, scanned and attached within one email to            Jan Harvey, Clinical Coordinator.


APPLICATION for Practicum (choose your program)

(A student handbook will be available online soon.)

SITE SUMMARY forms (for students starting the Graduate Counseling program Fall 2011 and after OR Marriage and Family therapy Fall 2012 and after)


Forms for Internship




Practicum Notebook Forms

Consent Forms (PDF files)

Consent Form - Minor
Consent Form - Adult

Onsite Supervision Rating Form - for Counseling, Marriage and Family Therapy, and Counseling Psychology (PDF files)

Evaluation Form for Site Supervisor (PDF)
Student Evaluation of Practicum Site

Other Forms (PDF files)

Faculty Evaluation of Counseling videos    (Video evaluation form)
Faculty Evaluation of MFT videos                  (Video evaluation form)

Counseling Log
Documentation Site Hours

Final Grade Tabulation Forms (PDF files)

Tabulation Form for Counseling I
Tabulation Form for Counseling II
Tabulation Form for Co. Psy I
Tabulation Form for Co. Psy II
Tabulation Form for MFT I
Tabulation Form for MFT II
Tabulation Form for Internship I
Tabulation Form for Internship II

Completion of Practicum Hours Verification form   Word Document    PDF file

Questions or Comments? Contact Jan Harvey or call 615 248 1733