Counseling and Human Services
Clinical Placement Materials
Below students will find all the required paperwork for their clinical experiences. Students should select their specific program (i.e. Community, Rehabilitation, School, Student Affairs) and print their program’s checklist. They should then print out any necessary documents for their practicum or internship experiences. These documents can be found both in their specific program section, as well as the “All Programs” section which has documents across all five counseling tracks. The Community/Rehabilitation combined program should use “Rehabilitation” as their primary section.
Students entering their practicum or internship experiences should visit our online fieldwork modules. This provides a great deal of information that addresses specific clinical concerns that students will see when at their placements.
All Programs
- Clinical Experiences Manual
All students should review this document the semester before their placement to stay updated about the policies and procedures of clinical placement. - Site Supervisor Information Form
- Permission to Tape Form
- First Counseling Session Note
- Counseling Progress Note
- Group Work Progress Note
- Case Presentation Format
- Supervision Log
- Consultation Handout
- Consultation Summary Form
- Weekly Hour Log
- Semester Summary Form
- Counseling Interview Rating Form
Practicum-only forms
- Practicum Application
- Practicum Expectations Summary
- Practicum Contract
- Practicum Skills Evaluation Form
- Practicum Supervisor Evaluation of Student Form
- Practicum Site Evaluation Form
- Practicum Student Evaluation of Site Supervisor Form
- Practicum Student Evaluation of Doctoral Supervisor Form
- Practicum Verification Sheet
Internship-only forms
- Internship Application
- Internship Agreement
- Summary of Internship Expectations
- Internship Site Evaluation Form
- Internship Verification Form
- Internship Interim Contract
This is the form that is used when the intern will be at the site prior to the start of the semester, or after the semester has officially ended
Community Counseling Folder
- Community Counseling Track Clinical Checklist
- Review of Community Program Goals and Objectives
- Site Supervisor Evaluation of Community Counseling Intern
Rehabilitation Counseling Folder
- Rehabilitation Track Clinical Checklist
- Review of Rehabilitation Program Goals and Objectives
- Review of Community/Rehabilitation Program Goals and Objectives
- Site Supervisor Evaluation of Rehabilitation Counseling Intern
- Site Supervisor Evaluation of Community/Rehabilitation Counseling Intern
School Counseling Folder
- School Counseling Track Clinical Checklist
- Review of School Program Goals and Objectives
- Site Supervisor Evaluation of School Counseling Intern
- Suggested Exposure Form
- Referral to the School Counseling Intern Form
- Evaluation of the School Counseling Intern Services
Student Affairs Counseling Folder
- Student Affairs Counseling Track Clinical Checklist
- Review of Student Affairs Program Goals and Objectives
- Site Supervisor Evaluation of Student Affairs Counseling Intern
If you have any questions or concerns, please contact the Clinical Placement Coordinator