Practicum and Internship Handbook - Forms

1. The following forms must be reviewed and approved by the practicum/internship coordinator the semester before you begin your COUN 6303 or COUN 6348 I & II course:
   1. COUN 6303/COUN 6348 Application and Clinical Coursework Site Information
      
      
2. The following forms are due to your Practicum/Internship instructor by the second week of class:
   2. Clinical Fieldwork Contract
   3. Site Supervisor’s Letter
   4. Authorization To Release Educational Records
   5. Emergency / Crisis Management Plan
   6. Proof of Counselor Liability Insurance
      
      
3. The following forms are due as a means to evaluate your performance during your COUN 6303 or COUN 6348 experience; each instructor will specify course-specific due dates for the following:
   7. Evaluation of Student Performance; (completed by student and site supervisor) via Qualtrics
   8. Evaluation of On-Site Supervisor; (completed by student) via Qualtrics
   9. Evaluation of UHV Counseling Program (completed by site-supervisor) via Qualtrics
   10. Practicum/Internship Documentation Form via Texas Department of State Health Services
       • #F75-10962 Practicum form (Word format, 37 KB)
       • #F75-10962 Practicum form (Adobe Acrobat format, 27 KB)
   11. Observation Form for School Counseling Interns ONLY (completed by course instructor)

At completion of each Practicum, Internship I and Internship II course, two additional forms will be submitted. These forms include the Practicum/Internship Hours Summary Log and the Texas State Board of Examiners for Professional Counselors (TSBEPC) Practicum Documentation Form.

4. Professional School Counseling students must receive participate in the requirements of Texas Administrative Code Title 19, Part 7, Chapter 228, RULE §228.35.g. Ongoing Educator Preparation Program Support for Professional Certification, which states:

   Supervision of each candidate shall be conducted with the structured guidance and regular ongoing support of an experienced educator who has been trained as a field supervisor. The initial contact, which may be made by telephone, email, or other electronic communication, with the assigned candidate, must occur within the first three weeks of assignment. The field supervisor shall document professional practices observed, provide written feedback through an interactive conference with the candidate, and provide a copy of the written feedback to the candidate's site supervisor. Informal observations and coaching shall be provided by the field supervisor as appropriate. (1) Observations must be at least 135 minutes in duration in total throughout the practicum and must be conducted by the field supervisor. (2) An EPP must provide the first observation within the first six weeks of all assignments. (3) An EPP must provide a minimum of three observations during the term of the practicum.

   Therefore, within the three semesters of field experience at least 135 minutes of observation must be completed; with the first observation being live at the school practicum site and the remaining two observations completed by recorded sessions.
   
   
5. Institution course instructor will visit the site were Professional School Counseling and Clinical Mental Health Counseling students are collecting fieldwork hours. Institution instructor, student, and site supervisor will work collaboratively to ensure date, time, and location of meeting. Site visits are made each semester for COUN 6303, COUN 6348 I & II.

← Rights and Responsibilities :: Practicum and Internship Sites →