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Professional Counseling Program Application for
COUN 6303 Practicum in Counseling,
COUN 6348 Internship I and
COUN 6349 Internship II

Deadlines:

Spring Semester: Nov 1
Summer Semester: Apr 1
Fall Semester: July 1

This application is for the

Directions:
1. This Practicum/Internship Application must be completed and submitted to the practicum/internship coordinator for review and approval by the published application due dates.
2. A separate application is required for Practicum, Internship I and Internship II.
3. Once you have completed and submitted your application, you will be notified whether your site has been approved and you will be able to register for class.
4. Students will not be approved to register for practicum or internship without completing the application process.
Indicate which Clinical Course you wish to enroll in: COUN 6303: Practicum
COUN 6348: Internship I
COUN 6349: Internship II
Indicate your primary degree concentration: School Counseling (degree-seeking)
CMHC Counseling (degree-seeking)
CMHC Counseling with I am a Certified School Counselor (CSC) (degree-seeking)
Post-Graduate School Counseling Certification
Post-Graduate LPC
Identifying Information:

Student Name:

Last Name

First Name

MI

Home Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Cell Phone:

Home Phone:

Work Phone:

UHV Email:

Alternate Email:

Student’s Advisor:

Student ID#:
Indicate Semester & year you completed the below pre-requisite courses:

COUN 6303: Practicum in Counseling

COUN 6310: Counseling in Schools

COUN 6311: Multicultural Counseling:

COUN 6321: Professional Orientation to Counseling and Ethics

COUN 6327: Theories of Counseling

COUN 6329: Group Counseling Theories and Techniques

COUN 6333: Counseling Techniques

COUN 6346: Introduction to Student Services in Higher Education

COUN 6350: Clinical Mental Health Counseling (CMHC Degree)

I have completed at least 30 hours in the Counseling Program: YesNo

Professional Counseling Program Application for
COUN 6303 Practicum in Counseling,
COUN 6348 Internship I and
COUN 6349 Internship II

This application is for the

Directions:

Identifying Information:

Student Name:

Home Address:

Indicate Semester & year you completed the below pre-requisite courses:

Student Contact and Clinical Coursework Site Information

Site Supervisor Information

Supervisor's Licensure Information

Site Information

Professional Counseling Program Application for COUN 6303 Practicum in Counseling, COUN 6348 Internship I and COUN 6349 Internship II

This application is for the

Directions:

Identifying Information:

Student Name:

Home Address:

Indicate Semester & year you completed the below pre-requisite courses:

Student Contact and Clinical Coursework Site Information

Site Supervisor Information

Supervisor's Licensure Information

Site Information

Professional Counseling Program Application for
COUN 6303 Practicum in Counseling,
COUN 6348 Internship I and
COUN 6349 Internship II