Appendix B - Forms & Information

 

Download the complete Appendix B

1. Declaration
2. Consent Form for Participation in Counseling Practicum
3. Transportation Storage of Confidential Client Data
4. 4-Way Agreement
5. CHHD In-person Internship Practicum Clinical Sites COVID19 Agreement
6. CHHD In-person Internship Practicum Clinical Sites COVID19 Agreement_SAMPLE
7. In-Person Internship Student Acknowledgement
8. In-Person Internship Student Release of Liability
9. In-Person Internship Student Release of Liability_SAMPLE
10. BBS Supervision Agreement
11. BBS Weekly Summary of Hours of Experience
12. BBS MFT Experience Verification
13. BBS MFT Sample Letter of Agreement – Volunteer Supervision
14. Beginning Practicum Summary Log/Semester Accounting Form
15. Advanced Practicum Summary Log/Semester Accounting Form
16. Site Supervisor Mid-semester Evaluation of Student
17. Counseling 530: Beginning Practicum - Practicum Presentations Evaluation Rubric
18. Counseling 584, 590 & 591: Advanced Practicum- Practicum Presentations Evaluation Rubric
19. Counseling 511, 530 & 584: Professor Evaluation of Counselor Student/Trainee Dispositions & Professionalism
20. Counseling 511: Professor Evaluation of Counseling Student Clinical Skills in COUN 511
21. Counseling 530: Professor Evaluation of Counselor Practicum Trainee Clinical Skills; Case Conceptualization & Treatment Planning; Diversity
22. Counseling 584, 590 & 591: Professor Evaluation of Counselor Practicum Trainee Clinical Skills; Case Conceptualization & Treatment Planning; Diversity
23. Site Supervisor Final Evaluation of PCC/MFT Trainee
24. Student Assessment of Clinical Training Site
25. Student Evaluation of Site Supervisor
26. End of Semester Check-Out
27. COUN 530 e-Form
28. Sample Resume
29. Quick Notes