Clinical Mental Health Counseling. Practicum and Internship Information and Forms

Transcription

1 Clinical Mental Health Counseling Practicum and Internship Information and Forms

2 Clinical Mental Health Counseling Practicum & Internship Handbook Table of Contents Basic Requirements 3 Time 3 Supervision 4 Content 4 Overview Outline for Clinical Instruction 5 Guidelines 6 Developing a Practicum Placement 6 The Field Supervisor 7 Using a Job as a Practicum 7 Using Private Practice as a Practicum 8 Dividing Time Between Two Placements 8 Evaluation 8 Professional Liability Insurance 8 Securing Outside Supervision 9 Application for the Practicum/Internship 9 Professional Commitment 9 Documentation Requirements 9 Withdrawal from Practicum/Internship 10 Tips for Choosing a Practicum Site Application for CMHC Practicum 14 Application for CMHC Internship 15 Practicum/Internship Contract for CMHC Internship Site Evaluation Written Notification of Withdrawal from Practicum/Internship 20 CMHC Client Contact and Supervision Record Expanded Counseling Skills and Dispositions Rubric Basic Attitudes/Values and Dispositions Rubric 26 LPC Licensing Requirements 27 2

3 Practicum/Internship The practicum/internship experience provides a guided transition from the academic setting to the professional field of work at a supervised entry level. Practicum/internship activities are many and varied, drawing upon the student s entire range of preparation and experience. The activities and requirements of the practicum/internship are aimed at preparing human service/mental health workers for a diverse field of practice. Such preparation involves the continued personal development of the counselor as a person, the further acquisition of specialized skills and knowledge and first-hand exposure to the day-to-day job requirements to which counselors are expected to function in specific work settings and with different population groups. BASIC REQUIREMENTS A. Time Practicum: The program requires students to complete supervised practicum experiences that total 100 clock hours at an approved practicum site. The practicum provides for the development of individual counseling and group work skills under supervision. The student s practicum includes the following: A minimum of 40 hours of direct service with clients appropriate to the program, so that experience can be gained in individual and group interactions. At least 20% of the total 100 hours must be in individual counseling and at least 25% of all direct service hours must be in group work; A minimum of one (1) hour per week of individual site supervision (using audiotape, videotape, and/or direct observation) over a minimum of one academic term; One hour and thirty minutes per week of group supervision on-campus; One hour per week of individual or triadic supervision by a full-time faculty member on campus and evaluation of the student s performance throughout the practicum including a formal evaluation at the completion of the practicum. Internship I and II: The program requires students to complete a supervised internship of 600 clock hours at an approved internship site that is begun after successful completion of the student s practicum. The internship is for two consecutive semesters. (A part-time student may take a longer time period to complete the required hours by enrolling for additional internship classes.) Consideration should be given to selecting internship sites that offer opportunities for the student to engage in both individual counseling and group work. The internship provides an opportunity for the student to perform under supervision a variety of activities that a regularly employed staff member in the setting would be expected to perform. A regularly employed staff member is defined as a person occupying the professional role to which the student is aspiring. The student s internship includes the following: A minimum of 240 hours of direct service with clients appropriate to the program of study; Weekly interaction with an average of one (1) hour per week of individual supervision throughout the internship, usually performed by the on-site supervisor; 3

4 2 hours and 30 minutes per week of group supervision on campus, throughout the internship; The opportunity for the student to become familiar with a variety of professional activities other than direct service; The opportunity for the student to develop audio and/or videotapes of the student s interactions with clients appropriate to the student s interest or specialization for use in supervision; The opportunity for the student to gain supervised experience in the use of a variety of professional tools such as assessment instruments, computers, print and non-print media, professional literature, research, and information on referral to appropriate resources; A formal evaluation of the student s performance during the internship by a program faculty supervisor and consultations with the site supervisor. A student in internship II who has not completed 80% of the required hours (480 total hours/190 direct client contact hours) at completion of the course must register for COUN 593: Counseling Seminar: Clinical Supervision, to complete the required hours. B. Supervision: There is a minimum requirement of one hour per week of individual supervision. Qualified supervisors are trained professionals who have the following qualifications: 1. A minimum of a master s degree in counseling or a related profession with equivalent qualifications, including appropriate certifications and/or licenses; 2. A minimum of two years of pertinent professional experience in the program area in which the student is enrolled (CACREP, 2009, p.14). C. Content: Overview and Orientation for Clinical Fieldwork Phase The fieldwork phase of the Community Counseling Program is clearly the culmination of skill development and knowledge acquisition the student has obtained during many months of study. To get the most out of the fieldwork phase of the program, it is important that students and their on-site supervisors have a clear grasp or the big picture regarding the educational goals during this phase of the program. To that end, this document has been prepared as a brief overview of the educational goals and expected outcomes for the field work experience. First, it should be clear that the ultimate goal of the Community Counseling Program in general is to produce well educated professional counselors capable of providing counseling services in a competent and ethical manner. With this in mind, the overall counseling curriculum has been organized around four domains of clinical practice. They include: 1. Building broad-based skill competencies; 2. Developing the ability to conceptualize the nature of a client s struggle; 3. Constructing an appropriate counseling plan aimed at assisting the client, and 4. Actively addressing the counselor s own personal deficits and working toward positive growth for the purpose of reaching fuller potential as a counselor and a person. Although each of the courses that comprise the counseling program addresses one or more of the aforementioned domains of clinical practice, it is during the field placement where each of these practice elements comes into full play simultaneously. Despite in-depth skill practice and concentrated attention to practice-related knowledge acquisition, the experience of applying all aspects of clinical practice upon entering a real-life setting can often be 4

5 overwhelming for the student intern. In response, we have worked toward helping the student to build his/her practice repertoire in a stepwise progression by emphasizing very specific elements in each of the three courses that serve to comprise the field experience. The on-site clinical supervisor and on-campus instructor have the task of monitoring and evaluating the student s progress in the specified areas of focus as the student progresses through each of the courses that comprise the field experience phase of the program. Student evaluations will be competency-based and guided through the use of our evaluation rubrics, which have been attached. For a student to progress from Practicum to Internship I and from Internship I to Internship II, he/she must be able to demonstrate increasing levels of competence and adequately reach the goals set for the semester s work. The on-campus supervisor will base assessment on evidence provided in written work, in class performance, and through consultation with the on-site clinical supervisor. OVERVIEW OUTLINE FOR CLINICAL INSTRUCTION Practicum: Broad Educational Goal: The practicum is thought to be a formal orientation period to the counseling setting and clinical work. As such the educational goals for this portion of the fieldwork placement are aimed at helping the student establish a solid base of clinically related skills and professional role skills. Specific areas of emphasis for meeting educational goals are listed below: Introduction to field placement, clientele served, policies and procedures of the organization, etc.; Issues of professional practice in a naturalistic setting; Application of a range of clinically related skills Conduct of intake Use of micro-skills in counseling sessions Case conceptualization Contextual Assessment and how it may impact the counseling process (e.g. spirituality, culture, race, ethnicity, sexual orientation, SES, etc.) Treatment planning Goal setting Tracking client progress Termination of counseling Clinical writing Etc. Professional Role Skills Application of ACA Code of Ethics and CT statues governing practice Maximize use of on-site supervision Maximize use of on-campus clinical instruction and group seminar discussion Management of in-session discomfort Professional Presentation and Demeanor Addressing issues of limits to competence Etc. 5

6 Internship I: Broad Educational Goal: Upon entering Internship I the student is understood to have established a degree of mastery regarding the basics of establishing rapport within the context of the counseling relationship and the ability to employ a variety of counseling skills in service to the client. In Internship I the student is expected to continue to build on this base while attending to the challenge of developing a theoretical context upon which the application of counseling skills and techniques are based. Specific areas of emphasis for meeting educational goals are listed below: Specific Emphasis I: The application of counseling theory for the purpose of informing counseling practice as it applies to the counseling process of client change. Specific Emphasis II: Special topical seminar discussions regarding common problems or issues with which clients often present Substance abuse The family system and use of the genogram in counseling Therapeutic use of the client s meaning-making belief system (functional spirituality) Cultural-sensitive counseling The counselor and psychopharmacology Trauma and abuse The angry and/or violent client Internship II: Broad Educational Goal: Counseling has been referred to as an art and a science. The emphasis on science increases during Internship II. In this final phase of the fieldwork experience students will focus attention on learning more about how outcome research can help to inform counseling approach, program design, and outcome evaluation. Specific areas of emphasis for meeting educational goals are listed below: Specific Emphasis I: Application of counseling process and outcome research to counseling practice. Students can expect to read research journal articles that address issues of treatment and outcome and demonstrate how such research has been employed in writing the counseling plan and served as an influence in the counselor s work. GUIDELINES A. Developing a Practicum Placement The choice of a practicum/internship reflects a student s career goals. An objective of the practicum/internship is for students to function as a counselor and to receive supervision in an area of specialization. Thus, the practicum/internship serves to validate the student s increased capacity to be a professional counselor. Students are encouraged to make exploratory contact with settings which correspond to their career goals. Students, along with the contact person from the setting, need to assess the potential training opportunities which the setting has to offer. It is the student s responsibility to make a determination about whether a proposed placement setting can reasonably meet one s needs and whether one s expectations are realistic. Advisors in the Department of Counseling and Family Therapy are available to consult with students about their placement. 6

7 B. The Field Supervisor The field supervisor is a professional colleague in counseling practice who has been authorized by his/her employing institution or by the Department of Counseling and Family Therapy to provide appropriate guidance and direction to the practicum/internship student. The field supervisor fulfills the following duties and responsibilities: To negotiate the practicum/internship contract between the student and the placement site with respect to specific expectations and time commitments; To gain clearance from appropriate administrators and working colleagues relevant to accommodating the practicum experience; To orient the student to the work setting and to operations policies; To arrange the student s work schedule; To monitor the student s on-the-job performance; To meet with the student at least weekly for case review, tape critique and personal feedback; To make recommendations to the practicum instructor relevant to the evaluation of performance in the field component of the practicum. It is expected that students will not arrange supervision with someone with whom he/she is also relating to in some other capacity, i.e. counselor, spouse, lover, friend, etc. this is to avoid the possibility of a dual relationship with supervisors. C. Using a Job as a Practicum At times students are fortunate enough to work at a site where there is the opportunity to use the site as a placement for their Practicum or Internship. In order that you have a productive and educationally enriching experience, the following guidelines have been developed: To begin the process of using your job as a placement, you must first meet with the Internship Coordinator, Dr. Judi Durham. She will schedule a meeting with the site supervisors as appropriate. The practicum/internship must give you the opportunity for new learning. On your practicum/internship contract, it must be clearly delineated what the new learning will be at the site and a description of how this will be differentiated from, or incorporated into your employment duties. Your employment supervisor must not be your placement supervisor. (This is in keeping with the ACA Code of Ethics that states that dual relationships are to be avoided.) You must be allowed to be a student learner. In other words, there must be a provision for you to receive the support that any other student intern would receive to help support them in becoming a proficient counselor. If you will be working with the same client population as you do for your job, your new role of a graduate intern must be made clear with the clients, as you would in any setting regardless of population. If you have any questions about the feasibility of using your site for the practicum/internship, this should be discussed with the Internship Coordinator, Dr. Judith Durham. Refer to the CACREP guidelines (below) for clinical instruction and supervision: 7

8 Clinical Instruction: A clinical instruction environment, on or off campus, is conducive to modeling, demonstration, and training and is available and used by the program. Administrative control of the clinical instruction environment ensures adequate and appropriate access by the faculty and students. The clinical instruction environment includes all of the following: Settings for individual counseling with assured privacy and sufficient space for appropriate equipment (i.e. TV, monitoring and taping); Settings for small group work with assured privacy and sufficient space for appropriate equipment; Necessary and appropriate technologies that assist learning, such as audio, video, and telecommunications equipment; Settings with observational and/or other interactive supervision capabilities; and Procedures that ensure that the client s confidentiality and legal rights are protected. A site supervisor must have: A minimum of a master s degree in counseling or a related profession with equivalent qualifications, including appropriate certifications and/or licenses; A minimum of two (2) years of pertinent professional experience in the program area in which the student is completing; Knowledge of the program s expectations, requirements, and evaluation procedures for students. D. Using Private Practice as a Practicum Students may not use private practice as a placement unless the practice has been approved by the Department. E. Dividing Time Between Two Placements Occasionally a student wants a varied training experience. Although it is considered optimal to complete a practicum in one setting for reasons of continuity, integration into an agency and exposure to a given system, it is allowable, in some instances, to divide between two placements. Both practicum placements and the Coordinator of the Practicum need to be aware of this arrangement. F. Evaluation At the end of each semester, the On-site Supervisors complete a rubric asking for an evaluation of the student s progress. This evaluation should be mutually discussed and signed, after which the student will return it to the on-campus supervisor AND give a copy to the Department of Counseling and Family Therapy for his/her file. In addition, the student will complete an evaluation of the on-site supervisor. The advisors in the Department of Counseling and Family Therapy are available to discuss the Practicum/Internship. Please consult with your advisor for more clarification of your training needs. G. Professional Liability Insurance Liability insurance is mandatory. The American Counseling Association (ACA) provides the opportunity to acquire professional insurance at a special rate for students. However, membership in ACA is necessary to purchase this insurance. It is available through ACA Insurance Trust and may be obtained via their website: Students should speak to their advisor about membership in the ACA. 8

9 H. Securing Outside Supervision Situations sometimes arise when clinical supervision is not available at the practicum/internship site. There can be a number of reasons for this: the lack of credentials and/or expertise of the site supervisor; or the inability of the site to provide weekly time for supervision. In such cases the practicum/internship student may choose to stay with the internship and arrange for supervision outside the agency at his/her own expense. Negotiations for outside supervision are to be completed prior to the beginning of the internship. I. Application for the Practicum/Internship Students need to meet with the Practicum/Internship Coordinator prior to registration to have his/her signature on the Application. Students cannot register for the practicum/internship course until the practicum/internship site and on-site supervisor is approved, their application is signed, and the completed/signed application is submitted to the Counseling Institute Office along with a copy of the student s professional liability insurance documentation, the on-site supervisor s resume and the student s contract with the agency. J. Professional Commitment Practicum/Internship students are responsible for securing their own practicum/internship placement. The decision to choose a particular placement depends on the career goals of the student and the mission of the sponsoring agency. Students need to assess the services of the agency, its target population, its theoretical orientation, and the professional personnel prior to making their decision. Once a student is accepted for a practicum, the student is the link between the agency and the Department of Counseling and Family Therapy. In accepting this responsibility, students are expected to fulfill their obligations to the practicum site for the specified period of time which they negotiated. As professionals, students understand their professional responsibilities to their clients, to the sponsoring agency, and to the Department of Counseling and Family Therapy. Students are expected to fulfill their professional commitments and to demonstrate effective ways to negotiate these obligations to the sponsoring agencies policies and personnel. On campus practicum supervisors are available to facilitate learning experiences and to address potential trouble areas. DOCUMENTATION REQUIREMENTS The following MUST be kept on file in the Department of Counseling and Family Therapy Office: Approved application for practicum/internship form Approved contract with goals for the semester Resume of your on-site supervisor Brochure or information on new site(s) Copy of your professional liability insurance All items listed above must be on file PRIOR to registration for Practicum. Due Dates: Fall=July 15 Spring=November 15 Summer-March 15 Also needed are the following: 9

10 Client Contact/Supervision forms: The student must keep a record of the hours with their clients and the hours they are in supervision. These are due monthly to the Department of Counseling and Family Therapy office no later than the 7 th of the following month, i.e. September hours are due by October 7 th. On-site supervisor s evaluation of the student: The evaluation rubric is due to the campus practicum supervisor one week prior to the end of classes. Students are to bring a copy to the Department of Counseling and Family Therapy Office at the same time. Student s evaluation of on-site supervisor: This form is due one week prior to the last class and should be submitted to the Office of Counseling and Family Therapy Office. Also included in your information packet is the Progress Notes sheet as a guideline for students to use after they have seen a client. It is expected that the student will write up case notes after each session. If the on-campus practicum supervisor or the on-site supervisor prefers another form, students are to follow their direction in this matter. POLICY FOR STUDENT WITHDRAWAL FROM PRACTICUM AND INTERNSHIP TRAINING SITE: Students may wish to withdraw from their practicum or internship sites for a number of reasons, including dissatisfaction with the educational opportunities offered by the site. An appropriate withdrawal or termination from a site is important for the student s clients, the site supervisor and the site, the student, and the Department of Counseling and Family Therapy. When site-related problems do arise, students should discuss their concerns with their site supervisor so that steps can be taken to improve the conditions. (Of course, the student may also want to consult with campus supervisors, advisors, and other SJC faculty to map out the appropriate steps to be taken to deal with the concerns.) In the event that the student determines that withdrawal is the only viable option, students should inform their site supervisor, their campus supervisor, and their advisor of her/his decision, giving a two-week notice of termination. The student should follow verbal notification with written notification as described in the Notification of Student s Withdrawal from Practicum/Internship Training Site form. 10

11 Department of Counseling and Family Therapy Tips for Choosing a Practicum/Internship Site General Resources SJC faculty/advisor Department files on sites previously used by SJC practicum/internship students Practicum/Internship Handbook Networking with student peers and alumni United Way list of agencies and phone numbers CT Department of Mental Health listings Newspapers search the job classifieds and volunteer opportunities. Look under counselor, mental health, therapist, healthcare, social services, or a specific discipline such as drug and alcohol. Phone books under counseling, mental health, social services, child care, hospitals, etc. State professional organizations, such at CT Chapter of the American Counseling Association Run a computer search for Connecticut Social Services or Connecticut Counseling Agencies etc. Questions to Ask Yourself What is my motivation for becoming a counselor? With what types of people do I want to work? With what types of problems am I interested in helping? What theoretical orientation(s) interest(s) me? How would I describe my personality? What is my learning style and what will I need to meet my personal learning needs? To what kind of supervision do I respond best (autonomy vs. more directive)? What are my short and long term goals? Where do I see myself in 8 months? 5 years? Questions to Consider During the Interview What is my impression of the quality of supervision? Is the supervisor experienced in teaching/working with interns? Is my potential supervisor interested in areas similar to mine? Is this supervisor someone I can work with? How does this supervisor view his/her role? Am I comfortable with this? 11

12 Will the supervisor be accessible for supervision, guidance, and instruction, even if my hours are in the evening? Will there be other clinicians with whom I can consult? Does the potential supervisor appear tolerant and open to new ideas and others views? Are the ethics at the site congruent with my own? What are the treatment approaches at the site and am I comfortable with the site s theoretical orientation? Will I be exposed to a variety of approaches such as performing assessments, individual and group counseling? Do I have a good understanding of how much time will be spent on direct client contact hours, paperwork, answering phones, etc.? Will this site be able to meet the requirements of Saint Joseph College s Counselor Education Program? Are there learning opportunities that I would consider interesting and challenging? Are the site s clients among those with whom I have expressed an interest? Is the program setting (school, nursing home, hospital, etc.) one where I would feel comfortable? Taking into consideration my career plan and motivation for being a counselor, will this site help me get there? Am I still somewhat undecided about my particular interests in counseling? If so, would a site with a variety of clients/problems be more appropriate? Practical Issues Will I be able to manage the commute and schedule? Is the location as convenient as I need based on my other obligations? Does the site take into account my current training, but at the same time stretch my skills while not extending beyond a point where I would be uncomfortable? Do I feel safe at this site or wherever they would ask me to go? Additional Helpful Hints Plan to interview at several sites. Do not decide after the first interview. Obtain professional liability insurance (see your student handbook). Once the appointment is made, send a cover letter with your resume attached. Practice your job-interviewing skills and be prepared to answer the following questions: Why are you interested in becoming a counselor? Why are you interested in this site? Why counseling rather than social work? What skills can you bring to this site? What is your theoretical orientation? The interview should be just like any job interview, put your best foot forward. Dress appropriately. Ask questions that are important to you. 12

13 Whenever possible, talk with other clinical workers at the site, including interns, former interns, etc. Be prepared to talk about the internship agreement hours expected, etc. Send a follow-up letter after the interview. Once placement is agreed upon, construct your personal practicum site goals that part of the contract you will present to your site supervisor. Have the contract signed by the site supervisor and campus supervisor. Prepare for your site placement by reading articles, books, etc. related to your site. Ask your supervisor for suggestions to help you prepare. Compiled from personal experiences of past students and these references: Baird, B. N. (2002). The internship, practicum, and field placement handbook: A guide for the helping professions (3 rd ed.) Upper Saddle river, NJ: Prentice Hall. Faiver, C., Eisengart, S., & Colonna, R. (2000). The counselor intern s handbook (2 nd ed.) Belmont, CA: Wadsworth/Thomson Learning. Sweitzer, H.F. & King, M.A. (1999). The successful internship: Transformation and empowerment. Pacific Grove, CA: Brooks/Cole Publishing Company. 13

14 Department of Counseling and Family Therapy APPLICATION FOR CLINICAL MENTAL HEALTH COUNSELING PRACTICUM Student: Name: Address: Phone: I plan to do my practicum (dates) Practicum Setting: Name of Site Site Supervisor Name license/certification (Please provide site supervisor s resume to the Department of Counseling and Family Therapy) Supervisor Address Phone Professional Liability Insurance is mandatory. (ACA Insurance accepted.) Please attach documentation as application will not be approved without documentation. Recommendation of Saint Joseph College Academic Advisor I recommend this student for practicum/internship. I do not recommend this student for practicum/internship at this time. I recommend this student for practicum/internship under the conditions on reverse side of this page. SJC Advisor s Signature (date) SJC Site Coordinator Signature (date) Student s Signature (date) 14

15 Department of Counseling and Family Therapy APPLICATION FOR CLINICAL MENTAL HEALTH COUNSELING INTERNSHIP Student: Name: Address: Phone: I plan to do my internship (dates) Internship Setting: Name of Site Site Supervisor Name license/certification (Please provide site supervisor s resume to the Department of Counseling and Family Therapy) Supervisor Address Phone Professional Liability Insurance is mandatory. (ACA Insurance accepted.) Please attach documentation as application will not be approved without documentation. Recommendation of Saint Joseph College Academic Advisor I recommend this student for practicum/internship. I do not recommend this student for practicum/internship at this time. I recommend this student for practicum/internship under the conditions on reverse side of this page. SJC Advisor s Signature (date) SJC Site Coordinator Signature (date) Student s Signature (date) 15

16 Department of Counseling and Family Therapy Practicum/Internship Contract for M.A. in Clinical Mental Health Counseling Student Name: Telephone: Address: Agency Name: Telephone: Agency Address: Supervisor's Name: Degree/Title: Supervisor's Telephone: This agreement is between Saint Joseph College Department of Counseling and Family Therapy and regarding the placement of Agency name Student name from to for at least hours per week. The practicum/internship student will receive the following supervision on-site: a. Primary Supervisor, will meet with the student hours per week to discuss b. Supplementary Supervisor, will meet with the student hours per week to discuss The practicum/internship student will be compensated as follows: We, the undersigned, understand that for Practicum at least 20% of all direct service hours must be in individual counseling, and a minimum of 25% in group counseling. On-site Supervisor s Signature Student s Signature Please return one copy of this contract to your on-site supervisor and one copy to the Counseling Department. Please complete Goals and Objectives on the following page. Thank you. 16

17 Statement of goals and objectives in this placement as discussed with the on-site supervisor including: Practicum Goals Required by Saint Joseph College 1. Introduction to field placement, clientele served, policies and procedures of the organization; 2. Application of a range of clinically related skills (see Practicum/Internship Content section); 3. Professional Role Skills (see Practicum/Internship Content section). Additional Goals suggested by Site Supervisor: Internship I Goals Required by Saint Joseph College 1. Clinical application and counseling theory to practice; 2. Introduction to the process of change as applied to working with individuals and groups; 3. Specific in-depth study of topics and issues pertinent to the clinical population served; 4. continued work on clinically related and professional role skills. Additional Goals suggested by Site Supervisor: Internship II Goals Required by Saint Joseph College 1. Clinical application of counseling process and outcome research to counseling practice. Additional goals suggested by Site Supervisor: 17

18 Internship Site Evaluation Site: Site Supervisor: Student: Date: This evaluation gives students the opportunity to provide feedback to their site and supervisor regarding the quality of their learning experience. In addition, these forms will be kept on file providing information to other students who may be interested in this site. 1. Were you provided an orientation to this site? (Introduction to staff, procedures, policies, etc.) Please describe: 2. How were the physical facilities? (Office space, supplies, etc.) 3. Comment on the organizational climate and receptivity to students: 4. Did the supervisor meet with you for contracted hours? Yes No 5. Was your supervisor available for consultation at times other than scheduled supervision? 6. Comment on the quality and nature of the supervision you received. 18

19 7. Were additional supervisory opportunities available? Describe. 8. Describe additional activities at the internship site that would have been useful to your growth and education as a counselor (but were not provided): 9. What extra learning opportunities were provided, i.e. inservice trainings, staff meetings, opportunities to observe other staff, etc.: 10. Please describe the weaknesses of the training or this training site: 11. Please describe the strengths of this training or training site: 12. How would you rate the overall experience? Fair Satisfactory Good Excellent Would you recommend this site for future students? Yes No Explain: 19

20 Written Notification of Student s Withdrawal from Practicum/Internship Training Site Prior to the Normally Scheduled End-Date Procedure: After verbally informing your site supervisor, campus supervisor, and advisor of the decision to withdraw, students should complete the following form and submit it to their advisor with copies to: Site Supervisor, Campus Supervisor, the Counseling Practicum Coordinator, and the Department of Counseling and Family Therapy s Department Chair. Date Submitted to Site Supervisor: Agreed Upon Date of Completion: Student s Name: Student s Signature: Practicum/Internship Site: Site Supervisor s Name: Site Supervisor s Signature: Reason(s) for withdrawal: Did you give a two-week notice to your site supervisor? Yes If No, please explain: No Please send the original of this form to your advisor and copies as shown above to others. Feel free to add additional comments on the back of this form or attach a separate sheet. 20