Practicum Forms - Mental Health Counseling

Student Forms:

The following forms are required of the student throughout the practicum experience.

*Please be sure to view this Due-Date List, so that you are aware of the due dates for each form.

• Counseling Practicum Checklist for Students—This checklist details all the pre-requisites for students pursuing registration in a counseling practicum. Completion of all parts of this checklist is necessary before students may be registered for (and therefore begin) their practicum.
• Practicum Pre-Registration Form - Upload this completed form to your e-portfolio and notify the Practicum and Internship Coordinator when you have finished this step.
• Mental Health Counseling Practicum Handbook: Students are required to read the practicum handbook before the beginning of their practicum.
• Checklist for Potential Supervisors - Once you have located an appropriate site and Site Supervisor, complete this form and upload it and your supervisor's resume to your e-portfolio. Notify the Practicum and Internship Coordinator when this step is complete. Your Site Supervisor must be approved before you can enter into a contract with the site/Site Supervisor. The Practicum and Internship Coordinator will notify you when your Site Supervisor has been approved.
• Practicum Contract—This contract between the student, Site Supervisor, and Practicum and Internship Coordinator represents the agreements of each to appropriately participate in the practicum experience and must be signed and uploaded to your e-portfolio prior to registration.
• Mid-Term Self-Evaluation—This evaluation is to be completed by the student, reviewed with the Site Supervisor, and uploaded to the student's e-portfolio.
• Final Self-Evaluation—This evaluation is to be completed by the student, reviewed with the Site Supervisor, and uploaded to the student's e-portfolio.
• Site Evaluation —This evaluation is to be completed by the student and uploaded to the student's e-portfolio. This evaluation is considered confidential.
• Informed Consent Form —This form must be signed prior to any counseling sessions. (Spanish version available)
• Counseling Practicum Weekly Summary Log—Students will fill out these logs each week based on their practicum experiences.
• Counseling Practicum Semester Summary Log—Students will fill out this log at the end of the practicum, acquire their Site Supervisor’s signature, and upload the log to the student's e-portfolio.

Site Supervisor Forms:

The following are forms that the Site Supervisor should complete during the student's practicum experience.  The student is responsible to make sure that his/her Site Supervisor is provided with these forms

• Mid-Term Practicum Student Evaluation—This evaluation is to be completed by the Site Supervisor, reviewed by the student, and uploaded to the student's e-portfolio.
• Final Practicum Student Evaluation—This evaluation is to be completed by the Site Supervisor, reviewed by the student, and uploaded to the student's e-portfolio.
• Evaluation of the Messiah Graduate Program—This evaluation is to be presented to the Site Supervisor by the practicum student and then upon completion uploaded to the student's e-portfolio.

Faculty Supervisor Forms:

• Final Practicum Student Evaluation—This evaluation is to be completed by the Faculty Supervisor, reviewed by the student, and uploaded to the student's e-portfolio.