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

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

This application is for the

  1. 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.
  2. Indicate which Clinical Course you wish to enroll in:

  3. Indicate your primary degree concentration:

  4. Identifying Information:

    Student Name:




    Home Address:












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

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

Student Contact and Clinical Coursework Site Information

Complete the following information and submit to the Practicum/Internship Coordinator. This information will be used to contact you, to contact your site supervisor, and for site visits by the university faculty.

  • All information must be completed.
  • Students must submit a separate set of contact information for each supervisor or location where clinical field experience will be completed.
  • Practicum/Internship Site Supervisors must have at least a master’s degree in counseling or related field and be credentialed as a Certified School Counselor (CSC), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or licensed Psychologist.

Site Supervisor Information

Supervisor's highest degree

Supervisor's degree discipline

Supervisor's Licensure Information


Site Information

Site Name and Physical Address of Practicum / Internship:






Supervisor’s Phone: