UHV SCHOOL PSYCHOLOGY PROGRAM HANDBOOK

Transcription

1 UHV SCHOOL PSYCHOLOGY PROGRAM HANDBOOK For more information about UHV's School Psychology program, please contact Program Director, Dr. Elise Hendricker UHV School of Arts & Sciences 3007 North Ben Wilson, Victoria, TX Phone: (361) Toll free in Texas (877)

2 Table of Contents Program Introduction & Overview Program Mission & Philosophy. 3 Program Goals & Objectives. 4 Professional Dispositions... 6 Program Faculty Profiles... 7 Academic Advisement & Orientation 8 New Student Advising Requirement.. 8 Prerequisites & Program Degree Requirements 8 Recommended School Psychology Plan of Study. 10 School Psychology Fieldwork Experiences Practicum 12 Internship Comprehensive Examination. 20 Licensure & Certification Change of Program 22 Concurrent Enrollment in School Psychology Program 22 Assessment and Continuous Improvement Process Assessment of Student Progress. 22 Annual Review Faculty Evaluation Form.. 24 Academic/Behavioral Remediation & Probation Professional Development. 28 Professional Affiliations. 29 Page 2

3 Program Introduction You are now a graduate student in the Specialist in School Psychology program at the University of Houston-Victoria. Congratulations! You have chosen one of the most outstanding training programs in the region. The UHV School Psychology program is outstanding because it has an excellent faculty from diverse backgrounds with applied school psychology skills and teaching and research skills. Furthermore, the UHV School Psychology faculty is genuinely concerned about your growth, development and success as a professional who will provide competent psychological services to children, families, and schools. Please take the time to get to know the school psychology core faculty because they will play an important role in your education and development into a Licensed Specialist in School Psychology (LSSP). The UHV psychology faculty expects you to exhibit the hard work and dedication necessary to acquire the skills and knowledge to be a successful school LSSP. We are prepared to work and partner with you to give you the opportunity to become a skilled and professional leader as an LSSP within the public schools of Texas and beyond. Program Overview The Specialist in School Psychology program is housed in the Social and Behavioral Sciences Division of the Arts & Sciences School of the University of Houston-Victoria. The program in school psychology is dedicated to providing students with a comprehensive, integrated program of study delivered by qualified faculty, as well as substantial supervised field experiences necessary for the provision of school psychological services, which positively impact children, youth, families, and the schools that serve them. The training standards within the program are consistent with both the National Association of School Psychologists (NASP) training standards and those of the Texas State Board of Examiners of Psychology (TSBEP) for the Licensed Specialist in School Psychology (LSSP) credentialing. Thus, upon completion of the program, students will be eligible to apply for the LSSP credential from the TSBEP and the Nationally Certified School Psychologist (NCSP) credential from NASP. The program is undergoing a continuous and data-based improvement process and is actively seeking NASP approved program recognition status. Program Mission & Philosophy The mission of the UHV school psychology program is to train entry-level school psychology practitioners, namely, Licensed Specialists in School Psychology (LSSP), in accordance to the standards set by the Texas State Board of Examiners of Psychology (TSBEP). The school psychology program has a core philosophy that emphasizes student development of competencies in the delivery of practical, ethical, and empirically sound services to a wide range of children in diverse learning environments. With emphasis on best practice application of school psychology, faculty and students are expected to be both consumers and evaluators of Page 3

4 empirically-based practice, while providing empirically-based school psychological services to a diverse population of individuals including children, families, school personnel, and other related professionals. Program Goals & Objectives Goal 1: Knowledge Base To prepare highly competent school psychology practitioners with excellent applied skills, who are grounded in a best-practice approach to meet the multifaceted needs of children and families and the schools that serve them. Objectives: 1. Students will be well grounded in the basic and applied knowledge areas, including but not limited to psychological foundations of behavior, educational foundations of behavior, psychological and psycho-educational assessment, direct and indirect interventions, and professional school psychology. 2. Students will demonstrate knowledge of empirically sound techniques of practice in the field of school psychology. 3. Students will be competent in and maintain utility of research to inform practice. Goal 2: Application/Interpretation To prepare high levels of clinical competency in assessment, consultation, counseling, and behavior management, all of which are characteristic of the professional practice of school psychology. Objectives: 1. Students will successfully complete both didactic and lab-based course work dealing with the theory, empirical support, and knowledge base in psychological and psychoeducational assessment, individual and system level consultation, problem identification and program development, individual and group based counseling, and program accountability. 2. Students will successfully complete practicum experiences that follow their clinically oriented courses. They will engage in supervised school based experiences designed to refine these clinical skills. 3. Students will be provided program-based opportunities to further develop their clinical skills in professional settings under professional supervision. 4. Students will engage in high quality school-based internships that complement and refine the competencies promoted in the didactic and practicum components of the program. Goal 3: Professional Practice/Performance Skills To foster, in students, a professional identity as LSSPs, who are knowledgeable about ethical and professional issues, understand and utilize special education and educational laws and regulations, and value the importance of interdisciplinary collaborations. Page 4

5 Objectives: 1. Students will attend, present posters/papers, and become involved with university program organizations, professional School Psychology organizations and meetings. 2. Students will be cognizant of, and utilize in their practice, current topics relevant to the practice of school psychology. 3. Students will demonstrate an awareness of, and ability to utilize, the most recent standards in ethical practice, educational and special education law, and federal, state and local legislation. 4. Students will learn and demonstrate the importance of collaboration across disciplines and specializations as necessary in order to fully develop their own professional identities as LSSPs. 5. Students will understand the importance of and have opportunities to participate in school and community partnerships. 6. Students will actively pursue advances in technology that can be used to facilitate assessment and intervention. Goal 4: Values To prepare culturally competent school psychology professionals to practice professionally in this increasingly culturally diverse society. Objectives: 1. Students will critically explore their own cultural identity and heritage and examine potential barriers to effective psychological service delivery. 2. Students will demonstrate knowledge and understanding of different cultures, value systems, developmental/identity issues related to culture and perspectives of healthcare and psychological services. 3. Students will demonstrate use of culturally competent consultation, intervention, and assessment practices to meet student, staff, and parental needs. 4. Students will demonstrate knowledge of ethical and legal issues related to multicultural competence in providing school psychology services and will be able to professionally evaluate ethical dilemmas in related services. Goal 5: Critical Thinking To prepare students who are able to engage in decision-making, problem solving, and use of critical thinking skills in the context of the school psychology profession. Objectives: 1. Students will demonstrate the ability to critically analyze and integrate data to derive recommendations appropriate for each client s presenting concerns. 2. Students will demonstrate flexibility and creativity in working within systems to accommodate multiple stakeholders and to maximize efficiency and effectiveness. 3. Students will actively pursue consultation and supervision to confirm, question, or challenge their thought processes and to continue developing critical thinking skills. Page 5

6 Professional Dispositions The School Psychology Program at the University of Houston Victoria is committed to an ongoing assessment of the program, the faculty, and the students. One aspect of this assessment is an appraisal of the student s personal and professional characteristics and work habits, which are reviewed as a component of the yearly student evaluation as well as the practica and internship evaluations. The following personal and professional characteristics are considered to be essential to the effective practice of School Psychology: 1. School psychologists are committed to their profession. They are aware of and meet the ethical and practice standards of their profession. They participate in professional organizations. Experienced school psychologists provide mentorship and guidance to those entering the profession. 2. School psychologists are committed to meeting the needs of children and families. They serve as advocates for children s needs. They work to promote system level change to better meet the needs of children and their families. 3. School psychologists are committed to diversity. They realize the essential worth of all people and the energy and wealth of ideas and experience that can be gained through diversity. They realize that good professional practice requires skills in assessment, consultation, counseling, and data based decision-making with individuals from a broad variety of cultures and backgrounds. School psychologists work to increase tolerance and respect for all individuals regardless of gender, disability, racial or ethnic identity, social or economic status, religion, or sexual orientation. 4. School psychologists are aware of the importance of technology as a tool as well as the ethical and practical considerations of its use. They work to use technology to increase efficiency in their work and access of services to children. 5. School psychologists display excellent communication skills. They are good listeners who utilize active listening techniques and display empathy. They can clearly communicate their ideas and complex information orally, and in writing, to diverse audiences such as parents, teachers, fellow school psychologists, and other professionals. 6. School psychologists display strong interpersonal skills. They are warm, empathetic, and compassionate. They are able to relate to a broad variety of individuals and form productive professional relationships. They are able to function effectively as a member of a multidisciplinary team. 7. School psychologists are reliable. They can be depended upon to meet their professional obligations in a timely manner. They display initiative and leadership on the job. 8. School psychologists display flexibility and tolerance for ambiguity. They are able to negotiate the complex social system of schools with patience and good humor. Page 6

7 School Psychology Program Core Faculty Dr. Elise Hendricker Dr. Shannon Viola Program Director Assistant Professor Internship/Practicum Supervisor Assistant Professor Office Phone #: (832) Office Phone #: (832) Meet Dr. Hendricker Dr. Hendricker is the Director of the UHV School Psychology graduate program. Dr. Hendricker is a Licensed Psychologist and Licensed Specialist in School Psychology (LSSP) in the state of Texas. She received her doctorate degree in School Psychology from the University of Missouri. She completed her pre-doctoral internship and post-doctoral fellowship with Cypress-Fairbanks Independent School District. Dr. Hendricker has experience working with all ages of students in school and community settings, including alternative schools, early childhood programs and juvenile justice programs. Her professional and research interests include the preparation and training of school psychologists, prevention and early intervention of academic and behavioral concerns, and building school capacity for family intervention. Meet Dr. Viola Dr. Viola is a Licensed Psychologist and Licensed Specialist in School Psychology (LSSP) in the state of Texas. She received her doctorate degree in School Psychology from Oklahoma State University. She completed her pre-doctoral internship and post-doctoral fellowship with Cypress- Fairbanks Independent School District. Dr. Viola has gained experience in working in public school settings with all ages of students. Dr. Viola s research interests pertain to children, families, improving education, and the lives of children. Areas of specific interest include Response to Intervention, parental involvement, and academic, behavioral, and social-emotional interventions. School Psychology Program Affiliated Faculty Dr. Paul Hamilton Clinical Assistant Professor Licensed Psychologist Licensed Specialist in School Psychology hamiltonp@uhv.edu Dr. Lacy Skinner Adjunct Professor Licensed Specialist in School Psychology lacy.skinner@cfisd.net Page 8

8 Academic Advisement & Orientation One of the most important people in your graduate education is your School Psychology Faculty Advisor. Your advisor is your advocate and confidant. Your advisor recommends and approves your degree plan, monitors your progress, approves course selection, helps you in securing practicum and internship placements, recommends students for graduation and assists you in the job search. As soon as possible after admission to the school psychology degree program, but no later than during the first semester of work, the student should contact his or her assigned school psychology advisor to develop a Degree Plan for the Specialist Degree. During an individual conference, the school psychology faculty advisor will assist the student with selection of courses for the each semester. After the student's degree plan is signed by the advisor and department head and approved by the Graduate School, the student is expected to follow it as the basis for all subsequent enrollments. The degree plan is the primary advisement tool. It is completed early in the student s program, usually in the first semester and provides the listing of courses needed for graduation. The student is responsible for keeping the degree plan updated and for bringing the plan to advisement sessions. If your last name begins with A-J, your faculty advisor is Dr. Hendricker. If your last name begins with K-Z, your faculty advisor is Dr. Viola. Each student is required to consult with his or her school psychology faculty advisor before enrolling in classes for each respective semester. For further information or to schedule an advising session, please contact your faculty advisor. Student Advising Requirement: At the beginning of each academic year, all newly admitted and currently admitted graduate students will be invited to attend a Mandatory Psychology Graduate Studies orientation conducted by the UHV Psychology Faculty. During orientation, students will receive information regarding curriculum and program requirements, and will be introduced to the Psychology faculty members. If a student is unable to attend, he/she is required to contact his/her advisor to obtain important program information. Prerequisites & Program Degree Requirements Students should have evidence of having completed the following undergraduate or graduate courses before entering the school psychology program: statistics, research, and abnormal psychology. A particular course will be waived as a requirement if the student passes a Page 8

9 comprehensive final or its equivalent for the designated course with a grade of C or better. The exam may be taken no more than once for a particular course. Currently, the School Psychology Program is a 66-hour non-terminal degree that leads to a Specialist degree in School Psychology and meets the academic requirements for the Texas Licensed Specialist in School Psychology (LSSP) credential. With this licensing, you can practice as a Licensed Specialist in School Psychology in K-12 public schools in Texas. You are also eligible to apply for the Nationally Certified School Psychologist Credential (long form) from NASP. All students begin and typically follow through with the course of study in the official university catalog of their beginning year in the program. Please see the plan of study below, in which students are advised to follow consistently for successful and timely matriculation through the program. Page 9

10 Year & Term Year 1 Fall - 12 hours Year 1 Spring - 12 hours Year 1 Summer - 9 hours Recommended School Psychology Plan of Study (For students who enrolled in the program prior to Fall 2015) Fast Track (Full Time, completing coursework over 2 years) Part Time Study is also allowed. Required Classes & Experiences PSYC 6321 Advanced Abnormal Psychology (3-online) PSYC 6334 Theories & Issues in Psychotherapy (3-online) PSYC 6344 The Ethics & Profession of School Psychology (3-online) PSYC 6336 Introduction to Assessment (3-face to face) PSYC 6330 Life Span Development (3-online) PSYC 6341 Behavior Management (3-hybrid) PSYC 6324 Techniques of Child and Adolescent Psychotherapy (3-face to face) PSYC 6345 Integrated School-Based Assessment I (3-face to face) PSYC 6331 Multicultural Psychotherapy (3-online) PSYC 6300 Early Childhood Assessment (3-hybrid) LITY 6331 Instruction for Students with Literacy Difficulties (3-online) Year 2 Fall - 12 hours Year 2 Spring - 12 hours Year 2 Summer - 3 hours Year 3 Fall - 3 hours Year 3 Spring - 3 hours PSYC 6315 Advanced Learning (3- online) PSYC 6326 Advanced Research Methods (3-online) PSYC 6340 School Consultation (3-online) PSYC 6348 School Psychology Practicum in Consultation & Interventions (3-online with experiential components) PSYC 6328 Biological Psychology (3-online) PSYC 6332 Advanced Social Psychology (3-online) PSYC 6346 Integrated School-Based Assessment II (3-face to face) PSYC 6349 School Psychology Practicum in Assessment (3-online with experiential components) ELAS 6331 Education Law (3-online) Take Comprehensive Exam and Praxis II Licensure Exam PSYC 6305 Internship (3- online with experiential components) PSYC 6305 Internship (3- online with experiential components) Total of 66 hours Page 10

11 Year 1 Fall - 12 hours Year 1 Spring - 12 hours Year 1 Summer 6 or 9 hours Year 2 Fall - 12 hours Year 2 Spring - 12 hours Year 2 Summer 3 or 6 hours Year 3 Fall - 3 hours Year 3 Spring - 3 hours Total of 66 hours Recommended School Psychology Plan of Study (For students who enrolled in the program during or after Fall 2015) Fast Track (Full Time, completing coursework over 2 years) Part Time Study is also allowed. Required Classes & Experiences (if starting the program in an odd year) PSYC 6334 Theories & Issues in Psychotherapy (3-online) PSYC 6344 The Ethics & Profession of School Psychology (3-online) PSYC 6336 Introduction to Assessment (3-face to face) PSYC 6315 Advanced Learning (3- online) PSYC 6341 Behavior Management (3-hybrid) PSYC 6345 Integrated School-Based Assessment I (3-face to face) PSYC 6332 Advanced Social Psychology (3- online) PSYC 6328 Biological Psychology (3-online) PSYC 6331 Multicultural Psychotherapy (3- online) PSYC 6300 Early Childhood Assessment (3- hybrid) LITY 6331 Instruction for Students with Literacy Difficulties (3-online) PSYC 6346 Integrated School-Based Assessment II (3-face to face) PSYC 6326 Advanced Research Methods (3- online) PSYC 6340 School Consultation (3-online) PSYC 6321 Advanced Abnormal Psychology (3- online) PSYC 6330 Life Span Development (3-online) PSYC 6324 Techniques of Child and Adolescent Psychotherapy (3-face to face) PSYC 6348 School Psychology Practicum in Consultation & Interventions (3-hybrid) PSYC 6349 School Psychology Practicum in Assessment (3-hybrid) ELAS 6331 Education Law (3-online) Take Comprehensive Exam and Praxis II Licensure Exam Required Classes & Experiences (if starting the program in an even year) PSYC 6334 Theories & Issues in Psychotherapy (3-online) PSYC 6344 The Ethics & Profession of School Psychology (3-online) PSYC 6336 Introduction to Assessment (3-face to face) PSYC 6340 School Consultation (3-online) PSYC 6341 Behavior Management (3-hybrid) PSYC 6345 Integrated School-Based Assessment I (3-face to face) PSYC 6332 Advanced Social Psychology (3- online) PSYC 6330 Life Span Development (3-online) PSYC 6331 Multicultural Psychotherapy (3- online) LITY 6331 Instruction for Students with Literacy Difficulties (3-online) PSYC 6346 Integrated School-Based Assessment II (3-face to face) PSYC 6326 Advanced Research Methods (3- online) PSYC 6315 Advanced Learning (3- online) PSYC 6321 Advanced Abnormal Psychology (3- online) PSYC 6328 Biological Psychology (3-online) PSYC 6324 Techniques of Child and Adolescent Psychotherapy (3-face to face) PSYC 6348 School Psychology Practicum in Consultation & Interventions (3-hybrid) PSYC 6349 School Psychology Practicum in Assessment (3-hybrid) ELAS 6331 Education Law (3-online) PSYC 6300 Early Childhood Assessment (3- hybrid) Take Comprehensive Exam and Praxis II Licensure Exam PSYC 6305 Internship (3) PSYC 6305 Internship (3) PSYC 6305 Internship (3) PSYC 6305 Internship (3) Page 11

12 SCHOOL PSYCHOLOGY PRACTICUM REQUIREMENTS Practicum Prerequisite Requirements Enrollment criteria for PSYC 6348 and 6349 (School Psychology Practica) includes the following: A C or better in the following pre-requisite or co-requisite courses: PSYC 6344 (Ethics and Profession of School Psychology) PSYC 6334 (Theories and Issues in Psychotherapy) PSYC 6340 (School Consultation) PSYC 6341 (Behavior Management) PSYC 6336 (Introduction to Assessment) PSYC 6345 (Integrated School-Based Assessment I) Practicum Site Requirements Students are required to complete two practica at 150 hours each: (1) A Consultation/Intervention Practica and (2) Assessment Practica. Practica may be completed in one semester (20 hours per week at one site for full-time students) or may be completed separately across two semesters (10 hours per week at one site for 2 semesters for part-time students). Each practicum student will be assigned a university supervisor who is a faculty member of the School Psychology Program and who holds an appropriate credential: either a Nationally Certified School Psychologist (NCSP), Licensed Psychologist, or Licensed Specialist in School Psychology (LSSP). University supervision will occur both at the practicum site and at the university or at any other mutually agreed upon place. The practicum student will be responsible for documenting for the university supervisor the duties s/he has performed. The university supervisor may also consult or confer with the field-based supervisor at any time regarding the practicum student s progress, and the university supervisor may request a formal evaluation if deemed appropriate. This option for formal evaluation may also be requested by the student or field-based supervisor. The university supervisor will serve as a consultant in mediating any difficulties and as a resource regarding technical information, ethics, standards procedures, rules and regulations, etc. All students will complete a self-evaluation and will be evaluated by their supervisors at the end of the practicum. Students who have not been enrolled the semester prior to practicum are required to take a pre-practicum competency to be considered for approval to complete practicum. Please see the School Psychology Practicum Handbook for specific details and forms. Note the School Psychology Practica Application below. Practicum Course Requirements Students are required to adhere to the following as well: 1. Students may not begin at a practicum site until it has been approved by the university supervisor and the Memorandum of Agreement and the UHV Affiliation Agreement has been signed by all parties. 2. Students will be required to register for the practicum class (PSYC 6349 or PSYC 6348), respective of the practica being completed that semester. Page 12

13 3. Students must complete two 150 hours of contact (per practicum) which may include administering testing measures, scoring protocols, providing interventions, providing counseling, etc. 4. Students are required to attend face-to-face and online meetings with the University supervisor as scheduled. 5. Practicum students must follow the NASP ethical code at all times. 6. Students must complete any other requirements as outlined in the practicum class syllabus. Page 13

14 . APPLICATION FOR SCHOOL PSYCHOLOGY PRACTICA PSYC 6348/PSYC 6349 (Circle which practicum you will be completing) Applications for School Psychology Practica must be turned in to Dr. Hendricker on the designated deadline date. Below are the School Psychology Practica application deadline dates: Practica Application Deadline Date Practica Start Date October 1 of the preceding semester Spring (Year) You must be officially accepted into the School Psychology Program and met all of the Practicum pre-requisite and co-requisite requirements in order to be considered eligible for Practica. Name: Application for Practica Semester: Spring (circle one) Year: Cumulative GPA: Number of Credit Hrs complete: Year/Semester Entered the Program: Practicum Verification of Coursework Semester/Year Grade (Required Courses) PSYC 6344 Ethics/Profession of School Psychology PSYC 6334 Theories and Issues in Psychotherapy PSYC 6340 School Consultation PSYC 6341 Behavior Management PSYC 6336 Introduction to Assessment PSYC 6345 Integrated School-Based Assessment I Page 14

15 UHV address (this will be the primary mode of contact): *You must provide a valid UHV address or you will not be considered for Practica. Telephone: (H) (C) Address: Please indicate 5 sites of interest, in which you plan to apply and the Practica Contact for that site: School Site Location (City) Site Contact & Contact Info. ( /phone) Approved course substitution or reasons for not completing any pre-requisite course: Student Signature Date Applicants must complete all course prerequisites and be in good academic standing to be considered for Practica. Permission from Practica Coordinator is required for enrollment in PSYC 6348/PSYC Psychology Practica course. Student liability insurance is required. Refer to the UHV catalog or contact the Practica Coordinator for more information. For Office Use Only: Student Name: Approve Deny: (Reason for Denial of Application ) Student notified: Y or N Date of Notification: Page 14

16 Student Practica Placement: Name of Site Supervisor: Phone/ of Site Supervisor Practica Coordinator Signature Date Page 15

17 SCHOOL PSYCHOLOGY INTERNSHIP CLASS REQUIREMENTS (PSYC 6305) In order to meet the program and licensing and certification requirements, students must complete a school-based internship with a minimum of 1200 clock hours in a public school or school system. As such, students must enroll in PSYC 6305 for two consecutive semesters. Students must apply for internship readiness by completing the School Psychology Internship Application (See Application below). The School Psychology Internship normally takes place across an academic year with a full-time assignment. As is appropriate for their professional skills and training, the program encourages all interns to be paid. The beginning and ending dates of the internship and the intern s working schedule are to be agreed upon by the student, onsite supervisor, and coordinator, but ordinarily encompass one school year. A minimum of 1200 hours must be completed by the end of the spring term and the student s self and supervisor evaluations should also be completed by this time so that grades can be assigned and the student can graduate in May. If the student applies for the LSSP before graduation and all parties agree, he or she may continue to work under supervision for the remainder of that school year. Throughout the internship the channels of communication shall remain open between the university, site, and the student, as the university must remain concerned with not only the student s well-being, but with that of the site and its clients, and with the university itself. Prior to beginning the school psychology internship, the site and site supervisor must be approved by the university supervisor and the Memorandum of Agreement for Internship must be signed by the student, the school site LSSP supervisor, and the University of Houston-Victoria school internship coordinator. According to the Texas Psychologists licensing law, section 22, students are exempt from TSBEP credentials or contract filing but must use a title indicating training status as Specialist in School Psychology Intern while delivering psychological services in the schools. The primary supervisor for the school psychology internship must be licensed as an LSSP in the state of Texas with 3 years of experience and must also be an employee of the school district in which the student is placed. A minimum of 2 hours supervision is required per week (one hour individual supervision with the primary supervisor, plus an additional hour which can be group or individual supervision and can be delegated to on-site personnel with competency in the area being supervised as long as primary supervisor has oversight). The university school psychology internship coordinator may make on-site visits at the end of the semester to lend support and monitor quality if feasible. The university school psychology internship coordinator is not an employee of the internship agency and therefore will not directly supervise student cases. The coordinator is available for support via phone and . Students who have not been enrolled the semester prior to practicum or internship are required to take a pre-practicum/pre-internship competency exam in the areas of (1) assessment, (2) intervention, (3) consultation, and (4) data-based decision making, arranged by the student s school psychology advisor. Please see the School Psychology Internship Handbook for further details. Note the School Psychology Internship Application below. Page 16

18 APPLICATION FOR SCHOOL PSYCHOLOGY INTERNSHIP (PSYC 6305) Applications for School Psychology Internship must be turned in to Dr. Hendricker via electronic document ed to Internship Application Deadline Date Nov. 1 Internship Start Date Fall You must be officially accepted into the School Psychology Program and completed the prerequisite and co-requisite courses in order to be considered eligible for Internship. Name: Application for Internship Semester: Fall Year: Prerequisite Evaluation Competency Work Samples: One of each evaluation competency work samples below must be submitted with your application. (1) Psychological Evaluation Sample (2) Psycho-educational Evaluation Sample (3) Autism Evaluation Sample (this may be submitted during Spring semester prior to Internship) Anticipated date of graduation: Cumulative GPA: Number of Credit Hrs complete: Year/Semester Entered the Program: UHV address (this will be the primary mode of contact): *You must provide a valid UHV address or you will not be considered for an Internship. Telephone: (H) (C) Address: Page 17

19 Please indicate 10 sites of interest below, in which you plan to apply and the Internship Contact for that site: School Site Location (City) Site Contact & Contact Info. ( /phone) SPECIALIST IN SCHOOL PSYCHOLOGY DEGREE INTERNSHIP VERIFICATION OF REQUIREMENTS Requirements Yes/No (Date) Score or GPA All courses complete except Internship UHV Comprehensive Exam Passed (Summer prior to Internship) Praxis II Passed (Summer prior to Internship) 3 Prerequisite Evaluation Competency Work Samples Satisfactory (to be evaluated by Internship coordinator) Approved course substitution or reasons for not completing any pre-requisite course: Page 18

20 Student Signature Date Applicants must complete all course prerequisites and be in good academic standing to be considered for Internship. Permission from Internship Coordinator is required for enrollment in PSYC Psychology Internship course. Student liability insurance is required. Refer to the UHV catalog or contact the Internship Coordinator for more information. For Office Use Only: Student Name: Approve Deny: (Reason for Denial of Application ) Student notified: Y or N Date of Notification: Student Internship Placement: Name of Site Supervisor: Phone/ of Site Supervisor Internship Coordinator Signature Date Page 19