Practicum and Internship Handbook: Forms for The Clinical Setting

Field Placement Forms

• Emergency/Crisis Management Form: The Emergency/Crisis Management Form is a resource for reporting urgent situations and getting immediate assistance.
• Client/Parental Consent Form: The Client/Parental Consent Form is used to obtain official permission from clients or parents before providing services or participation in programs.
• Practicum and Internship Ethics Agreement: The Practicum and Internship Ethics Agreement sets the ethical standards students must follow during internships and practical training.
• Practicum or Internship Summary: The Practicum or Internship Summary provides an overview of a student's experiences and learning outcomes during their practical training or internship.
• Trainee Consent for Video and Audio Recording: The Trainee Consent for Video and Audio Recording grants permission to record a trainee's sessions for educational or training purposes.
• Trainee Evaluation of Field Site and Supervisor: The Trainee Evaluation of Field Site and Supervisor allows students to provide feedback on their internship environment and mentorship experience.
• Site Information Form: The Field Site Information Form documents a student's approved placement site details for their practicum or internship.

Practicum Forms

• Practicum Field Placement Contract: The Practicum Field Placement Contract outlines expectations and responsibilities for students completing clinical field placements.
• Field Experience Plan: The Field Experience Plan for a clinical setting defines the schedule, placement site, and planned counseling activities for a trainee's practicum or internship in a clinical field placement.
• Field Site Supervisor Registration: The Field Site Supervisor Registration form registers a supervisor and documents their credentials and approval for overseeing a counseling trainee's field placement.
• Practicum Log: The Practicum Log form records a student's hours and activities during their practicum or internship placement.
• Directions for Keeping the Practicum Log: The Directions for Keeping the Practicum Log page explains how students must track and document their practicum or internship hours and activities correctly.
• Field Site Supervisor’s Evaluation of Practicum Trainee: The Field Site Supervisor's Evaluation of Practicum Trainee form is used to assess a trainee's performance and progress during their clinical practicum.

Internship Form

• Internship Field Placement Contract: The Internship Field Placement Contract defines the roles, responsibilities, and expectations for a trainee, supervisor, and site in a clinical-mental-health internship placement.
• Field Experience Plan: The Field Experience Plan for a clinical setting defines the schedule, placement site, and planned counseling activities for a trainee's practicum or internship in a clinical field placement.
• Field Site Supervisor Registration: The Field Site Supervisor Registration form registers a supervisor and documents their credentials and approval for overseeing a counseling trainee's field placement.
• Internship I Log: The Internship I Log form tracks a student's logged hours and activities during their first internship placement.
• Internship II Log: The Internship II Log form tracks a student's logged hours and activities during their first internship placement.
• Directions for Keeping the Internship Log: The Directions for Keeping the Internship Log page explains how interns should accurately record their hours and activities throughout their internship placement.
• Field Site Supervisor’s Evaluation of Internship Trainee: The Field Site Supervisor Evaluation of Internship Trainee form allows supervisors to assess an intern's performance and progress during their placement.

Other Forms

• Counseling Student Competency Evaluation: The Counseling Student Competency Evaluation form is used to assess a student's counseling skills, professionalism, and competency during their training.
• Between-Semester Hours: The Between-Semester Hours form helps track additional required hours completed by students between academic semesters.
• Between-Semester Log: The Between-Semester Log form tracks hours and activities completed by students between academic semesters.

For Documentation of Practicum and Internship Hours to State Board with your license application upon graduation:

• Use the Texas State Board of Examiners of Professional Counselors Practicum or Graduate Internship Documentation Form. You can execute one of these forms at the end of the semester for each of your clinical classes, one each for practicum, internship 1, and internship 2, three total.