Practicum and Internship
Clinical Mental Health Counseling &
Marriage, Couple, and Family Counseling
Practicum (CNS 591) and Internship (CNS 596)
- Practicum and Internship Manual (CMHC & MCFC)
- Approved Practicum & Internship Sites (NEW)
- List of Approved Sites (OLD)
Please follow the directions at the bottom of each form for completing and submitting the form in PDF format via email.
- Informed Consent
- Practicum Application Form *
- Practicum Site and Supervision Contract *
- Internship Site and Supervision Contract *
- Permission to Video
- Practicum/Internship Hour Log
- Site Supervisor Evaluation of Student Performance in Practicum (Midterm and Final)
- Site Supervisor Evaluation of Student Performance in Internship (Midterm and Final)
- Student Counselor Evaluation of Supervisor
- Student Evaluation of Site
* forms where only certain fields can be edited.
Related Departmental Policies
- CSA Policy on Security of Media (Video and Audio)
- Practice Preparation Sequence and Departmental Approval for Practicum and Internship Placement Policies
- Internship Grading
Directions for working with the Forms
- Right click on the link above and choose "save as," and save the file to your computer.
- Open the file you want to print or edit and modify if desired. After editing the file, save it.
- Attach it to email, print it, or save it for future editing.
- To view PDFs, you can download Adobe Reader free by going to http://get.adobe.com/reader/.
- To create PDF files, you can download CutePDF for free at http://www.cutepdf.com/.
Dates & Deadlines
- October 23, 2014 Submit mid-term evaluations to faculty supervisor for review and signature.
- December 5, 2014 Submit all final signed paperwork (WKU portfolio) to the Clinical Coordinator.
- January 19, 2015 Submit Spring Internship Contract and updated membership or insurance if expired.
- February 2014 Attend the Internship & Job Fair to identify future employment opportunities if desired.
- March 20, 2015 Submit mid-term evaluations to faculty supervisor for review and signature.
- May 8, 2015 Submit all final signed paperwork (WKU portfolio) to the Clinical Coordinator.
2015-2016 Practicum & Internship
- February 2014 Practicum & Internship Orientation (required for new practicum students).
- February 2014 Submit the Practicum & Internship Informed Consent Form to the Clinical Coordinator.
- February 2014 Attend the Internship & Job Fair
- February 2014 Submit the Practicum Application Form and associated documents to the Clinical Coordinator.
- March 2014 Review approved Site Information Forms and begin applying to sites of interest.
- March 2014 If all requirements have been met, you will be enrolled in the practicum group supervision course (CNS 591) by the Clinical Coordinator
- April 2014 Finalize practicum site placement and submit the Practicum Site and Supervision Contract.
- May 2014 Begin practicum
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,
Note: documents in Word format (DOC) require Microsoft Viewer,
Note: documents in Powerpoint format (PPT) require Microsoft Viewer,
Note: documents in Quicktime Movie format [MOV] require Apple Quicktime,