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