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.
- Practicum Application Form
- Practicum Site and Supervision Contract
- Internship Site and Supervision Contract
- Practicum/Internship Hour Log
- Practicum Evaluation of Student Performance (Midterm and Final)
- Internship Evaluation of Student Performance (Midterm and Final)
- Student Evaluation of Supervisor
- Student Evaluation of Site
- Permission to Video
- Plan of Action for Course Completion
- Petition for Change in Practicum or Internship Site
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:
- Site Information Form (form should be saved first and then completed in Adobe Reader or Pro)
- Site Visit Checklist
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
- 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
- March 2015 Review approved Site Information Forms and begin applying to sites of interest once application is approved by the Clinical Coordinator.
- March 30, 2015 If all requirements have been met, you will be enrolled in the practicum group supervision course (CNS 591) by the Clinical Coordinator
- May 1, 2015 Finalize practicum site placement and submit the Practicum Site and Supervision Contract.
- May 18, 2015 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,