EDCO 398 Counseling Practicum & Internship
Checklist of Forms/Assignments
The list below includes all of the forms and assignments for the Practicum/Internship experience. All of the items on this list are due in a packet submitted to the instructor at the end of each semester (unless otherwise indicated below). See Instructions for Checklist of Forms/Assignments for more information about these forms and submission requirements.
Student Name |
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Practicum Only |
Practicum & Internship |
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Date Submitted |
Description |
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Form #1 - Practicum & Internship Application (Only required prior to first semester. Indicate date submitted. Application does not need to be included in end of semester packet.) |
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Form #2 - Mutual Agreement Contract (Due prior to semester/start at placement. Staff must have a current Contract for each semester student is at placement. Please see CP staff to see if this form needs to be re-submitted during current semester. Indicate date discussed with staff. Include copy of Contract in packet at the end of the semester.) |
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Proof of Insurance (This must be submitted by student prior to working on site. Insurance must be valid for all of the semesters that student is working on site.) |
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Form #3 - Practicum Competency Checklist (Practicum students only. This form is completed by UVM supervisor/instructor. Student does not have to include this in packet [instructor has copy].) |
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Form # 4 -Internship Competency Checklist & Goal Setting (Separate forms for MH and SC Internships. Completed by site supervisor.) |
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Form #5 - Student Evaluation of Practicum & Internship Site (Completed by student.) |
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Form #6 - Student Evaluation of Site-Supervisor (Completed by student.) |
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Form #7 - Site-Supervisor’s Evaluation of the UVM Counseling Program (Completed by site-supervisor.) |
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Form #8 - Site-Supervisor’s Evaluation of Student (Completed by site-supervisor.) |
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Practicum & Internship Accountability Form (Completed by student. Original form [available from staff] must be used. All hours must match final Log of Hours. All signatures must be on form at time of submission. Student should retain copy of this form.) |
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Hour Logs (Hour logs for semester must be submitted at the end of the semester. Student should keep copies.) |
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Case Presentation (Does not need to be submitted in packet. Indicate date completed in class.) |
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Referral Log (Submit to instructor –does not need to be included in packet. Indicate date submitted.) |
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Reading List (Submit to instructor –does not need to be included in packet. Indicate date submitted.) |
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Dates of Site Visit(s) (Indicate: Site Visit/Phone Contact) |
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#2 |
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#3 |
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