Appendix B - Forms & Information
Download the complete Appendix B
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Declaration
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Consent Form for Participation in Counseling Practicum
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Transportation Storage of Confidential Client Data
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4-Way Agreement
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CHHD In-person Internship Practicum Clinical Sites COVID19 Agreement
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CHHD In-person Internship Practicum Clinical Sites COVID19 Agreement_SAMPLE
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In-Person Internship Student Acknowledgement
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In-Person Internship Student Release of Liability
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In-Person Internship Student Release of Liability_SAMPLE
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BBS Supervision Agreement
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BBS Weekly Summary of Hours of Experience
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BBS MFT Experience Verification
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BBS MFT Sample Letter of Agreement – Volunteer Supervision
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Beginning Practicum Summary Log/Semester Accounting Form
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Advanced Practicum Summary Log/Semester Accounting Form
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Site Supervisor Mid-semester Evaluation of Student
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Counseling 530: Beginning Practicum - Practicum Presentations Evaluation Rubric
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Counseling 584, 590 & 591: Advanced Practicum- Practicum Presentations Evaluation Rubric
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Counseling 511, 530 & 584: Professor Evaluation of Counselor Student/Trainee Dispositions & Professionalism
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Counseling 511: Professor Evaluation of Counseling Student Clinical Skills in COUN 511
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Counseling 530: Professor Evaluation of Counselor Practicum Trainee Clinical Skills; Case Conceptualization & Treatment Planning; Diversity
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Counseling 584, 590 & 591: Professor Evaluation of Counselor Practicum Trainee Clinical Skills; Case Conceptualization & Treatment Planning; Diversity
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Site Supervisor Final Evaluation of PCC/MFT Trainee
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Student Assessment of Clinical Training Site
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Student Evaluation of Site Supervisor
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End of Semester Check-Out
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COUN 530 e-Form
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Sample Resume
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Quick Notes