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Western Kentucky University

Counseling and Student Affairs

Practicum and Internship

Clinical Mental Health Counseling &
Marriage, Couple, and Family Counseling
Practicum (CNS 591) and Internship (CNS 596)


Required Clinical Paperwork

Please follow the directions for completing and submitting the form in PDF.

Additional Paperwork

Establishing and Maintaining Clinical Sites

Review the Practicum & Internship Manual for instructions on establishing a  new site or maintaining a clinical site.  The following are forms used for reviewing and updating sites annually:

Related Departmental Policies

Directions for working with the Forms

  1. Right click on the link above and choose "save as," and save the file to your computer.
  2. Open the file you want to print or edit and modify if desired. After editing the file, save it.
  3. Attach it to email, print it, or save it for future editing.
  4. To view PDFs, you can download Adobe Reader free by going to
  5. To create PDF files, you can download CutePDF for free at

Dates & Deadlines

2014-2015 Internship

  • May 8, 2015  Submit all final signed paperwork (WKU portfolio) to the Clinical Coordinator. Congratulations on finishing your internship!

2015-2016 Practicum & Internship

  • May 1, 2015: Finalize practicum site placement and submit the Practicum Site and Supervision Contract.
  • May 18, 2015: Begin practicum.
  • Jul 3, 2015: Submit mid-term evaluations to faculty supervisor for review and signature.
  • Aug 14, 2015: Submit all final signed paperwork (WKU portfolio) to the Clinical Coordinator. Contact CC if an extension is required. Must be submitted no later than 12/11/15.

Note: documents in Portable Document Format (PDF) require Adobe Acrobat Reader 5.0 or higher to view,
download Adobe Acrobat Reader.

Note: documents in Excel format (XLS) require Microsoft Viewer,
download excel.

Note: documents in Word format (DOC) require Microsoft Viewer,
download word.

Note: documents in Powerpoint format (PPT) require Microsoft Viewer,
download powerpoint.

Note: documents in Quicktime Movie format [MOV] require Apple Quicktime,
download quicktime.

 Last Modified 4/12/15