08/2016 1
Tentative School Practicum/Internship Guide
Subject to Change
Practicum and Internship Packet
For
Students, Interns, and Site Supervisors
COUN 6290 School Counseling Practicum
And
COUN 6291 School Counseling Internship
CACREP Accredited Since 1990
Preparing School Counselors at UNI since 1953
Graduate Program in Counseling
Clinical Mental Health Counseling and School Counseling
University of Northern Iowa
School Counseling Emphasis
08/2016 2
Table of Content
COUN 6290 School Counseling Practicum
General Guidelines
Practicum 2016 CACREP Standards
Conditional License as a School Counselor
Practicum Weekly Hours Log
Practicum Final Hours Log
COUN 6291 School Counseling Internship
General Guidelines
Responsibilities of the Cooperating School
Responsibilities of the University
Responsibilities of the Student Intern
Internship 2016 CACREP Standards
Internship Weekly Hours Log
Internship Final Hours Log
School/Clinical Mental Health Alumni Program Satisfaction Survey
Information & Forms for Both COUN 6290/6291
Audio and Video Taping Procedures for Practicum & Internship
Letter to Site Supervisor
Site Information Form
On Site Supervisor and Internship Student Agreement
Counselor-in-Training Evaluation of Skills (CITES)
Student Evaluation of Site Supervisor
Student Evaluation of Faculty Supervisor
Site Supervisors’ Evaluation of Program
08/2016 3
Practicum: COUN 6290 School Counseling Practicum
General Guidelines
1. The practicum requirements of the program have to comply with both the state
requirements and the CACREP standards. Additional requirements (e.g., reading,
journals, etc.) may be assigned by university supervisors for training purposes. Thus, the
Practicum and Internship Guide is subject to change. A latest edition will be disseminated
by your university supervisors.
2. University supervisor will hold an informational meeting with students enrolling in
practicum several weeks prior to the beginning of the semester. Enrollment is determined
by the course rotation with your advisor/clinical school counseling coordinator, and/or
the counseling program chair.
3. You will be responsible for attaining the practicum sites at all levels (K-8 and 5-12). You
must also remain at sites throughout the semester. In anticipation of receiving Iowa K-12
Professional Service License, you must go by the requirements of the Board of
Education. As such, a minimum of 100 hours of practicum and/or internship
experiences must be completed at each level.
Requirements of the Iowa Board of Education.
K-8 5-12
A minimum of 100 hours
(direct plus indirect)
out of 700 Practicum and Internship hours
A minimum of 100 hours
(direct plus indirect)
out of 700 Practicum and Internship hours
*If there is an overlap of hours, they can count toward either level.
4. By the end of practicum, you must document a minimum of 100 hours. These 100 hours
must include 40 hours direct contact (20 at each level of elementary through secondary).
This is a great opportunity to be in the field and supervised and mentored by experienced
professionals. Many students have more than 100 hours during practicum.
5. It is your responsibility to ensure that you complete minimum hours at all levels during
your practicum and internship. If you plan to have jobs by the time you take internship, it
is highly advisable to obtain as many practicum hours as possible at the levels opposite
than the one you plan to take internship.
08/2016 4
Practicum
K-8 5-12
20 direct contact hours minimum 20 direct contact hours minimum
*Minimum total 100 hours (direct plus indirect)
*The level in which you obtain more hours depends on the internship placement.
08/2016 5
Practicum 2016 CACREP Standards
Entry-Level Professional Practice
A. Students are covered by individual professional counseling liability insurance policies while
enrolled in practicum and internship.
B. Supervision of practicum and internship students includes program-appropriate audio/video
recordings and/or live supervision of students’ interactions with clients.
C. Formative and summative evaluations of the student’s counseling performance and ability to
integrate and apply knowledge are conducted as part of the student’s practicum and
internship.
D. Students have the opportunity to become familiar with a variety of professional activities
and resources, including technological resources, during their practicum and internship.
E. In addition to the development of individual counseling skills, during either the practicum or
internship, students must lead or co-lead a counseling or psychoeducational group.
Practicum
F. Students complete supervised counseling practice experiences that total a minimum of 100
clock hours over a full academic term that is a minimum of 10 weeks.
G. Practicum students complete at least 40 clock hours of direct service with actual clients that
contributes to the development of counseling skills.
H. Practicum students have weekly interaction with supervisors that averages one hour per
week of individual and/or triadic supervision throughout the practicum by (1) a counselor
education program faculty member, (2) a student supervisor who is under the supervision of
a counselor education program faculty member, or (3) a site supervisor who is working in a
consultation on a regular schedule with a counselor education program faculty member in
accordance with the supervision agreement.
I. Practicum students participate in an average of 1.5 hours per week of group supervision on a
regular schedule throughout the practicum. Group supervision must be provided by a
counselor education program faculty member or a student supervisor who is under the
supervision of a counselor education program faculty member.
08/2016 6
Supervisor Qualifications
J. Counselor education program faculty members serving as individual/triadic or group
practicum/internship supervisors for students in entry-level programs have (1) relevant
experience, (2) professional credentials, and (3) counseling supervision training and
experience.
K. Students serving as individual/triadic or group practicum/internship supervisors for students
in entry-level programs must (1) have completed CACREP entry-level counseling degree
requirements, (2) have completed or are receiving preparation in counseling supervision,
and (3) be under supervision from counselor education program faculty.
L. Site supervisors have (1) a minimum of a master’s degree, preferably in counseling, or a
related profession; (2) relevant certifications and/or licenses; (3) a minimum of two years of
pertinent professional experience in the specialty area in which the student is enrolled; (4)
knowledge of the program’s expectations, requirements, and evaluation procedures for
students; and (5) relevant training in counseling supervision.
M. Orientation, consultation, and professional development opportunities are provided by
counselor education program faculty to site supervisors.
N. Written supervision agreements define the roles and responsibilities of the faculty
supervisor, site supervisor, and student during practicum and internship. When
individual/triadic practicum supervision is conducted by a site supervisor in consultation
with counselor education program faculty, the supervision agreement must detail the format
and frequency of consultation to monitor student learning.
08/2016 7
Conditional License as a School Counselor
If students who have completed the core courses in their program of study, and do not have a
teaching background EXCEPT for practicum and internship, may apply for a conditional license
to practice as a school counselor in Iowa (applications at the BOEE). Students that currently
hold an Iowa teaching license can apply for their conditional license after completing 12 credits
in the program. If you call the BOEE with questions, make sure you note the date,
information shared, and the person providing the information.
Iowa Department of Education: https://www.educateiowa.gov//
Board of Educational Examiners (BOEE) licensing
Those holding the license and seeking license:
http://www.boee.iowa.gov/
http://www.boee.iowa.gov/seeking_other.html (professional Service License)
08/2016 8
School Counseling Practicum
University of Northern Iowa
Practicum Weekly Hours Log
Name: ______________________ Site: _________________Semester/Year: _____________
Site Supervisor: ___________________________________
Week/
School
Levels
Direct Contact Hours Indirect Hours Supervisor Initials
Ind
ivid
ual
Gro
up
Co
nsu
ltat
ion
Cla
ssro
om
Wo
rk
Sta
ffin
g (
wit
h
clie
nt
pre
sen
t)/
Oth
er
Supervision Professional Tasks
Ind
ivid
ual
sup
erv
isio
n
Gro
up
sup
erv
isio
n
Pre
par
atio
n
Pap
erw
ork
Mee
tin
gs/
trai
nin
gs
oth
er
Week 1 Total
K-8
5-12
Week 2 Total K-8 5-12 Week 3 Total K-8 5-12 Week 4 Total K-8 5-12 Week 5 Total K-8 5-12 Week 6 Total
K-8
5-12 Week 7 Total K-8 5-12 Week 8 Total K-8 5-12 Week 9 Total K-8 5-12
08/2016 9
Week/
School
Levels
Direct Contact Hours Indirect Hours Supervisor Initials
In
div
idu
al
Gro
up
con
sult
atio
n
Cla
ssro
om
Wo
rk
Sta
ffin
g (
wit
h
clie
nt
pre
sen
t)/
Oth
er
Supervision Professional Tasks
Ind
ivid
ual
sup
erv
isio
n
Gro
up
sup
erv
isio
n
Pre
par
atio
n
Pap
erw
ork
Mee
tin
gs/
trai
nin
gs
oth
er
Week 10
Total
K-8
5-12
Week 11
Total
K-8 5-12 Week 12
Total
K-8
5-12 Week 13
Total
K-8 5-12 Week 14
Total
K-8 5-12 Week 15
Total
K-8 5-12 Week 16
Total
K-8 5-12 Week 17
Total
K-8 5-12
08/2016 10
School Counseling Practicum or Internship
University of Northern Iowa
Practicum Final Hours Log
Name____________________________Semester/year_____________Week_____________
Site Supervisor_____________________ Site_______________________
Direct Hours at K-8:
Individual Counseling __________
Group Counseling __________
Consultation with client present __________
Clinical Staffing with client present __________
Classroom Work __________
Total Direct Hours at K-8 __________
Indirect Hours at K-8:
Related clinical work
Preparation for clinical work __________
Paperwork __________
Meetings or Trainings __________
Other __________
Total Related Clinical Work __________
Individual Supervision
On-site __________
University __________
Total Individual Supervision __________
Group Seminar/Supervision __________
Total Indirect Hours at K-8 __________
(Add totals from related clinical work, individual supervision, and group seminar)
08/2016 11
Direct Hours at 5-12:
Individual Counseling __________
Group Counseling __________
Consultation with client present __________
Clinical Staffing with client present __________
Classroom Work __________
Total Direct Hours at 5-12 __________
Indirect Hours at 5-12:
Related clinical work
Preparation for clinical work __________
Paperwork __________
Meetings or Trainings __________
Other __________
Total Related Clinical Work __________
Individual Supervision
On-site __________
University __________
Total Individual Supervision __________
Group Seminar/Supervision __________
Total Indirect Hours at 5-12 __________
(Add totals from related clinical work, individual supervision, and group seminar)
08/2016 12
GRAND TOTAL HOURS __________
Student signature: _______________________________ Date: ________________
Site Supervisor Signature (K-8): ____________________________ Date: ______________
Site Supervisor Signature (5-12): ____________________________ Date: ______________
University Supervisor Signature: ____________________________ Date: ______________
08/2016 13
Internship: COUN 6291 School Counseling Internship
General Guidelines
1. The school will provide the student intern with a paid or non-paid work experience which
will help him/her prepare for employment in a school setting.
2. The student must put in a minimum of 600 hours (20 hours/week over two semesters or
40 hours/week over one semester) on-site in a school over no more than two academic
terms. In anticipation of receiving Iowa K-12 Professional Service License, a
minimum of 100 hours of practicum or internship experiences must be completed at
both K-8 and 5-12 levels. It is your responsibility to ensure that you complete
minimum hours at all levels during your practicum and internship.
3. The student must be supervised on-site by a person with at least a master’s degree in
school counseling, with at last two years of professional experience in counseling, and
evidence of continuing professional development activities.
4. On-site supervision should include one hour per week face-to-face supervision, including
critique of the intern’s actual counseling sessions (live supervision or listening to tapes)
and completing site supervisor critique forms.
5. The student will have the opportunity for individual or triadic supervision with university
faculty weekly, and group seminar will be for either 1.5 hours weekly or 3 hours bi-
weekly in addition to on-site supervision. If students placed or employed at a distance
from campus for internship then distance supervision technology is utilized for both
individual/triadic supervision and group supervision.
08/2016 14
Responsibilities of the Cooperating School
2. Interview the potential intern. If the interview is successful, a schedule for the internship
can be planned. If the interview is not successful, please contact the university internship
supervisor.
3. Designate an individual who will be the site supervisor for the student intern. Once a
student is approved for the internship placement, all contact regarding the student will be
addressed to the site supervisor.
4. Provide an opportunity for the intern student to participate in the routine professional
activities of the practicing master’s level counselor. These should include – individual
and small group and/or family counseling; career counseling; if applicable, scoring and
interpretation of tests for clients being counseled; use of educational, occupational and
personal-social information; consultation with parents and staff; referral of clients; staff
meetings; parent groups; classroom guidance. At the internship level, it is especially
critical that students become involved with all aspects of the school counseling program
in that they are familiar with the fours components of comprehensive school counseling
programs; responsive services, educational planning, psychological education, and
program management.
5. The designated site supervisor should:
a. Inform the intern about the policies and procedures governing the placement site;
b. Participate in the development of the intern’s plan for the semester(s);
c. Spend a minimum of one hour per week supervising the intern’s work, including
critiques of the intern’s actual case counseling (individual, small group, and
classroom guidance sessions);
d. Make provisions for the student intern to attend meetings, conferences,
workshops, etc. which the site supervisor normally attends;
e. Inform the university instructor of any concerns regarding the intern’s current
functioning level, or concerns regarding the intern’s potential for becoming a
productive, professional counselor; and
f. Complete a mid-term and a final evaluation each semester of the student intern’s
performance on forms provided by the university.
6. A site supervisor may expect as a result of his/her role:
a. Input from the university supervisor in designating the intern experience;
b. Assistance from the student intern in lightening the workload; and
08/2016 15
c. Stimulation and professional growth from the experience of
supervising/mentoring.
08/2016 16
Responsibilities of the University
1. Approve students for registration in the internship and for placement through the area’s
internship coordinator and instructor.
2. Arrange placement of students through cooperating schools. Placements will be arranged
at least 30 days in advance.
3. Provide a department instructor who will serve as liaison within the internship site.
4. The university instructor’s responsibilities include:
a. Communicating with the site supervisor and the student intern prior to or during the
first two weeks of the internship to review the student’s internship plan;
b. Maintain regular contact with the site supervisor by phone, e-mail, or on-site visits
over the course of the semester;
c. Meeting individually, in dyads, or in triads for additional supervision with the student
intern during the semester. At least one site visit will be made during the semester by
the instructor at the intern’s site;
d. Provide further instruction and critiquing during on-campus seminars (1.5 hours/week
– 15 weeks);
e. Critique the student intern’s performance; and
f. Assign course evaluation (pass-no credit) after consultation with site supervisor.
08/2016 17
Responsibilities of the Student Intern
1. Arrange through the Clinical School Counseling Coordinator and student’s advisor to
register for the internship. The student is responsible for completing all prerequisites and
meeting deadlines to insure appropriate placement.
2. Prepare a proposed plan for the internship experience by the end of the second week of
the semester. The plan should include the student’s goals, the activities to achieve the
goals, expectations for the supervisor, and a plan for assessing the experience. The plan
should be endorsed by the site supervisor and the university instructor.
3. Perform the counseling functions agreed to tin the internship plan and other functions as
directed by the site supervisor.
4. Work to improve performance in response to feedback made by the site supervisor and
the university instructor.
5. Meet as scheduled with the site and university supervisors for critique of work, including
actual individual, small group, and classroom guidance seminar.
6. Keep a weekly log of activities experience and comment on areas of concern; complete
other forms weekly: individual session reports, group counseling and classroom guidance
lesson plans, and self-evaluations.
7. Prepare a final cumulative record of internship activities and amount of time spent on
each. (Must document a minimum of 240 direct client contact hours and 360 indirect
hours; minimum of 600 total.)
8. Student intern should already have professional liability insurance. Student intern’s need
to be sure it is up to date and current.
9. Be consistent with the requirements of the internship site with regard to professional
appearance, punctuality, and so forth.
10. Demonstrate behavior in accordance with the ACA ethical and professional standards.
11. Prepare a written self-evaluation of strengths, areas to improve, and learnings at the end
of the internship experience.
08/2016 18
12. Meet with the site and university supervisors each semester for a mid-term and final
evaluation of the internship.
08/2016 19
2016 CACREP Internship Standards
Section III
Professional Practice
Professional practice, which includes practicum and internship, provides for the application of
theory and the development of counseling skills under supervision. These experiences will
provide opportunities for students to counsel clients who represent the ethnic and demographic
diversity of their community.
Entry-Level Professional Practice
J. Students are covered by individual professional counseling liability insurance policies while
enrolled in practicum and internship.
K. Supervision of practicum and internship students includes program-appropriate audio/video
recordings and/or live supervision of students’ interactions with clients.
L. Formative and summative evaluations of the student’s counseling performance and ability to
integrate and apply knowledge are conducted as part of the student’s practicum and
internship.
M. Students have the opportunity to become familiar with a variety of professional activities
and resources, including technological resources, during their practicum and internship.
N. In addition to the development of individual counseling skills, during either the practicum or
internship, students must lead or co-lead a counseling or psychoeducational group.
Internship
J. After successful completion of the practicum, students complete 600 clock hours of
supervised counseling internship in roles and settings with clients relevant to their specialty
area.
K. Internship students complete at least 240 clock hours of direct service.
L. Internship students have weekly interaction with supervisors that averages one hour per
week of individual and/or triadic supervision throughout the internship, provided by (1) the
site supervisor, (2) counselor education program faculty, or (3) a student supervisor who is
under the supervision of a counselor education program faculty member.
08/2016 20
M. Internship students participate in an average of 1.5 hours per week of group supervision on a
regular schedule throughout the internship. Group supervision must be provided by a
counselor education program faculty member or a student supervisor who is under the
supervision of a counselor education program faculty member.
Supervisor Qualifications
N. Counselor education program faculty members serving as individual/triadic or group
practicum/internship supervisors for students in entry-level programs have (1) relevant
experience, (2) professional credentials, and (3) counseling supervision training and
experience.
O. Students serving as individual/triadic or group practicum/internship supervisors for students
in entry-level programs must (1) have completed CACREP entry-level counseling degree
requirements, (2) have completed or are receiving preparation in counseling supervision,
and (3) be under supervision from counselor education program faculty.
P. Site supervisors have (1) a minimum of a master’s degree, preferably in counseling, or a
related profession; (2) relevant certifications and/or licenses; (3) a minimum of two years of
pertinent professional experience in the specialty area in which the student is enrolled; (4)
knowledge of the program’s expectations, requirements, and evaluation procedures for
students; and (5) relevant training in counseling supervision.
Q. Orientation, consultation, and professional development opportunities are provided by
counselor education program faculty to site supervisors.
R. Written supervision agreements define the roles and responsibilities of the faculty
supervisor, site supervisor, and student during practicum and internship. When
individual/triadic practicum supervision is conducted by a site supervisor in consultation
with counselor education program faculty, the supervision agreement must detail the format
and frequency of consultation to monitor student learning.
08/2016 21
School Counseling Internship
University of Northern Iowa
Internship Weekly Hours Log
Name: ______________________ Site: _________________Semester/Year: _____________
Site Supervisor: ___________________________________
Week
Direct Contact Hours Indirect Hours Supervisor
Initials
Indiv
idual
Gro
up
Consu
ltat
ion
Cla
ssro
om
Work
Sta
ffin
g (
wit
h
clie
nt
pre
sent)
/
Oth
er
Supervision Professional
Tasks
Indiv
idual
super
vis
ion
Gro
up
super
vis
ion
Pre
par
atio
n
Pap
erw
ork
Mee
tings/
trai
nin
gs
oth
er
1
2
3
4
5 6 7 8 9 10 11 12 13 14 15
08/2016 22
School Counseling Internship
University of Northern Iowa
Internship Final Hours Log
Name____________________________Semester/year_____________Week_____________
Site Supervisor_____________________ Site_______________________
Direct Hours:
Individual Counseling __________
Group Counseling __________
Consultation with client present __________
Clinical Staffing with client present __________
Classroom Work __________
Total Direct Hours __________
Indirect Hours:
Related clinical work
Preparation for clinical work __________
Paperwork __________
Meetings or Trainings __________
Other __________
Total Related Clinical Work __________
Individual Supervision
On-site __________
University __________
Total Individual Supervision __________
Group Seminar/Supervision __________
Total Indirect Hours __________
(Add totals from related clinical work, individual supervision, and group seminar)
08/2016 23
GRAND TOTAL HOURS __________
Student signature: _______________________________ Date: ________________
Site Supervisor Signature: ____________________________ Date: ______________
University Supervisor Signature: ____________________________ Date: ______________
08/2016 24
University of Northern Iowa
School/Clinical Mental Health Alumni Program Satisfaction Survey
1. Please indicate your program of study:
___ Mental Health Counseling ___ School Counseling
2. What term did you graduate?
______Summer ______Fall (December) ______Spring (May)
3. Year __________
4. Please indicate your racial/ethnic background, please check all that apply.
____African-American
____Asian
____European American
____Hispanic
____Native American/Islander
____Multi-racial
____Don’t know
____Prefer not to answer
____Another form of self-identifying diversity (e.g. Sexual orientation or disability)
_______________________________
5. What is your age? _______
6. What was the average distance you traveled roundtrip to class?
____ None, I live on campus
____ Less than 20 miles
____ 21-40 miles
____ over 40 miles
7. As a graduate student, you attended classes:
____ Part-time
____ Full-Time (at least 9 hours per semester)
____ Both
8. As a graduate student, were you employed:
____ Part-Time
____ Full-time
____ Unemployed
9. In terms of financial assistance, please check all that apply:
____ I did not receive financial assistance.
____ Information about financial assistance was available.
____ Financial assistance enabled me to pursue graduate study.
08/2016 25
PLEASE RESPOND WITH YOUR GENERAL PERCEPTIONS TO THE FOLLOWING
STATEMENTS
10. My coursework was valuable in pursuing my chosen career
Strongly Disagree 1 2 3 4 5 Strongly Agree
11. Classroom and other physical facilities provided a comfortable learning environment
Strongly Disagree 1 2 3 4 5 Strongly Agree
12. Adequate research resources and/or assessments were available
Strongly Disagree 1 2 3 4 5 Strongly Agree
13. Library services were accessible
Strongly Disagree 1 2 3 4 5 Strongly Agree
14. Overall, university services and support systems facilitated my graduate education
Strongly Disagree 1 2 3 4 5 Strongly Agree
15. I was satisfied with the teaching abilities of the full-time faculty
Strongly Disagree 1 2 3 4 5 Strongly Agree
16. I was satisfied with the teaching abilities of the part-time faculty
Strongly Disagree 1 2 3 4 5 Strongly Agree
17. All factors considered, I was satisfied with my graduate program
Strongly Disagree 1 2 3 4 5 Strongly Agree
18. My professors are available for help/questions outside of class.
Strongly Disagree 1 2 3 4 5 Strongly Agree
19. My courses are relevant to my chosen program of study.
Strongly Disagree 1 2 3 4 5 Strongly Agree
20. My professors have provided a clear understanding of the goals and requirements
of each class.
Strongly Disagree 1 2 3 4 5 Strongly Agree
21. Academic/professional interaction with others has contributed significantly to my
attaining my educational goals.
Strongly Disagree 1 2 3 4 5 Strongly Agree
22. Compared to when I entered the graduate program, I have a stronger ability to think
critically.
Strongly Disagree 1 2 3 4 5 Strongly Agree
23. I have enhanced my problem-solving skills as a direct result of being in this
program.
Strongly Disagree 1 2 3 4 5 Strongly Agree
24. Graduating from a CACREP accredited program has been beneficial to me
professionally
Strongly Disagree 1 2 3 4 5 Strongly Agree
REGARDING MY ACADEMIC ADVISOR
25. My advisor was a good listener and provided individual attention.
Strongly Disagree 1 2 3 4 5 Strongly Agree
08/2016 26
26. My advisor provided ample time to discuss problems and concerns.
Strongly Disagree 1 2 3 4 5 Strongly Agree
27. My advisor provided adequate information.
Strongly Disagree 1 2 3 4 5 Strongly Agree
IN THE JOB MARKET, DO YOU AGREE OR DISAGREE THAT THE PROGRAM HELPED
YOU ATTAIN THIS NECESSARY SKILL:
Communication skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Writing skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Interpersonal relationship skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Self-reliance skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Decision-making skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Ability to execute plans: Strongly Disagree 1 2 3 4 5 Strongly Agree
Ability to work in groups on projects: Strongly Disagree 1 2 3 4 5 Strongly Agree
Leadership skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Analytical skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Research skills: Strongly Disagree 1 2 3 4 5 Strongly Agree
Understanding personal strengths and weaknesses:
Strongly Disagree 1 2 3 4 5 Strongly Agree
Achieving personal goals: Strongly Disagree 1 2 3 4 5 Strongly Agree
Achieving career goals: Strongly Disagree 1 2 3 4 5 Strongly Agree
QUESTIONS 1-3 ARE SPECIFIC TO INTERNSHIP:
1. The experience was clearly defined and structured
Strongly Disagree 1 2 3 4 5 Strongly Agree
2. The experience requirements were valuable in preparation for job functioning
Strongly Disagree 1 2 3 4 5 Strongly Agree
3. My supervisor for this experience was aware of my professional strengths and
weaknesses and helped me to improve my professional skills.
Strongly Disagree 1 2 3 4 5 Strongly Agree
Questions 4-10 General questions:
4. I would recommend this program to a friend.
Strongly Disagree 1 2 3 4 5 Strongly Agree
08/2016 27
5. This program prepared me to be a multiculturally competent counselor.
Strongly Disagree 1 2 3 4 5 Strongly Agree
6. The difficulty level of this program is what I expected for graduate level studies.
Strongly Disagree 1 2 3 4 5 Strongly Agree
7. I expect to derive long-term benefit from this program.
Strongly Disagree 1 2 3 4 5 Strongly Agree
8. I had adequate leadership opportunities.
Strongly Disagree 1 2 3 4 5 Strongly Agree
9. I was mentored professionally and there were adequate opportunities to
professionally grow.
Strongly Disagree 1 2 3 4 5 Strongly Agree
10. I was successful at finding a job within one year.
Strongly Disagree 1 2 3 4 5 Strongly Agree
11. What three things do you think should be changed in your graduate program?
12. Add any other comments you want to share about your graduate experience.
13. Please identify two or three courses you feel contributed most to your
professional development:
***. As alum, would you like to be involved with the U.N.I. counselor education
program?
Check what you would like:
___ Receive e-mails (add e-mail address if so)
___ Receive Chi Sigma Iota newsletters
___ Informed of and come to University of Northern Iowa counselor education program
events
___ Counselor Education Advisory Board___ Member at large Chi Sigma Iota
Additional comments or
recommendations:_______________________________________________________________
______________________________________________________________________________
____________________________________________________________________________
08/2016 28
Information & Forms for Both COUN 6290/6291
Audio and Video Taping Procedures
Audio and/or videotaping is crucial, both for supervisory purposes and in order to protect the
interests of clients. Therefore, audio and/or video tape whenever appropriate.
1. If auto or videotaping is not possible at one site, you need to choose a different site that
will allow you to tape since the university supervisor does not provide live supervision.
Feedback on tapes is vital to counselor development.
2. Receiving parental consent for taping of children and adolescents is encouraged by UNI.
However, this decision is left to the discretion of respective school and/or school districts.
Forms are available.
3. It is essential that the purpose of the taping by explained to clients. In essence, indicate
that it is to help the trainee improve skills and that their identity will not be revealed to
others.
4. All tapes are to be listed to or viewed by the counselor trainee; they also will be shared
with the university instructors, and/or his/her designated on-campus supervisor, and by
the on-site supervisor. Occasionally, tapes are group critiqued in practicum or internship
seminar. However, no tape is shared in the seminar if the identity of the client is likely to
be evident, and no reference to the client’s last name is to be made. Listening to or
viewing a tape by the seminar is an activity that is entered into only after adequate
safeguards are taken to protect the identity and interests of the client. (Only first names
of the clients are to be used on tapes and/or forms).
5. After tapes have been critiqued, they are to be erased. This responsibility rests with the
counselor trainee.
6. Interview content, whether taped or not, is to be kept strictly confidential. All listening
to tapes, critiquing, and supervision are to be confined to private critique and supervisory
areas. Under no circumstances are clients, their identities, or the nature of their concerns,
to be discussed with persons other than supervisors or seminar members.
08/2016 29
Date: _____________
Dear Colleague:
Thank you for agreeing to supervise one of our School Counseling Practicum students for Fall 2016.
Because you have agreed to mentor and supervise an intern, you must be aware of the rewards. Practicum
and Internship supervision is the important link between the academic program of study and the
profession of practicing counselors. The process of practicum and internship ends with two individuals
knowing one another’s philosophy and skills in an intimate way; two individuals who are now and will
continue to be colleagues. Many of the requirements for Practicum and internship are detailed in our
CACREP accreditation standards. Our program has been CACREP accredited since 1990, but UNI has
been graduating counselors since 1953!
Supervision can involve a combination or activities which include didactic instruction, case discussion,
role plays, direct observation of sessions, joint therapy, frequent review of audio or videotapes, and
opportunities to observe the supervisor conducting counseling sessions. We recommend that both parties
(intern and supervisor) take an active role in discussing what kinds of learning experiences would be most
helpful during internship. Initial and on-going discussions, including a review of the information in the
packet are encouraged throughout the experience. One hour of weekly supervision by the site
supervisor meets our minimum requirements, live supervision of interns in counseling related
activities is necessary, especially if it is not possible to video or audio tape.
Our practicum students are required to do 100 contact hours, including 40 direct client (individual, group
or classroom) contact over the course of the semester and 90 of indirect time logged. Our interns are
required to do 600 contact hours, including 240 hours of direct client (individual, group or classroom)
contact over the course of the semester (or year if part time) and 360 of indirect time logged. Your
evaluation is needed both at midterm and at the completion of the Practicum and/or internship
experience. A copy of the Counselor-in-Training Evaluation of Skills (CITES) is provided in this
packet. Please use it for both midterm and the final evaluation. The student will not receive “credit”
until the final evaluation is received.
I will be available throughout the semester if you need to contact me and I may check in with you on our
student’s progress. At least once, I will visit your school. I am providing both my email and phone
contact information below if you have any questions please let me know and thank you for mentoring our
student!
Respectfully,
Dr. Pei-Chun (Olivia) Chen
209 Latham Hall
319-273-4314
08/2016 30
School Counseling Practicum or Internship
University of Northern Iowa
Site Information
Practicum Student or Intern Name ___________________________________________
Fall __________ Spring __________
School Counselor Practicum or Internship Site
School District _____________________________________________________________
School ____________________________________________________________________
Address ___________________________________________________________________
Site Phone _________________________________________________________________
Intern’s Cell Phone __________________________________________________________
Intern’s Email ______________________________________________________________
Supervisor Information
Supervisor _________________________________________________________________
Supervisor’s Position in School District __________________________________________
Phone _____________________________________________________________________
Email _____________________________________________________________________
(It is a required form for practicum and internship and signed copies by all parties should
be provided for: intern, site supervisor, and university supervisor.)
08/2016 31
School Counseling Practicum or Internship
University of Northern Iowa
On Site Supervisor and Practicum/Internship Student Agreement
Prior to beginning the practicum/internship experience, and after the practicum/internship
meeting with the instructor, the practicum/internship student should have this form signed by the
prospective on-site supervisor.
___________________________ (Intern’s name) has discussed the internship experience and
the CACREP requirements with me and has permission to work with students under my
supervision at:
Location: _____________________________________________________________
Semester & Year: ______________________________________________________
I understand that if I have further questions regarding the internship or if I am unable to resolve
any concerns with the student that I will contact the School Counseling Practicum or
Internship Instructor:
(Instructors contact information here)
(On site supervisor’s signature) (Date)
(Intern’s signature) (Date)
(Instructor approval) (Date)
(It is a required form for practicum and internship and signed copies by all parties should
be provided for: intern, site supervisor, and university supervisor.)
08/2016 32
School Counseling Practicum or Internship
University of Northern Iowa
Counselor-in-Training Evaluation of Skills (CITES)
Student _____________________________________
Program ______________________
Semester and Academic Year __________________
Faculty Supervisor ___________________________
On-Site Supervisor ___________________________
Mid-Semester Evaluation Date: ________________
End of Semester Evaluation Date: ______________
Supervisor: please complete the following evaluation of skills. Assessments should be consistent
with what is expected for other CITs with similar level of training and experience. For example,
a practicum student who scores a “4” would perform differently from an internship student who
scores a “4.”
N/A – not applicable or not observed
1 – low proficiency; 3 – on-target; 5 – exceeds expectations
Counseling skills
Counselor-in-training:
Develops a collaborative and therapeutic
relationship
N/A 1 2 3 4 5
Demonstrates effective group counseling skills N/A 1 2 3 4 5
Maintains appropriate structure such as session
times, location, duration of session
N/A 1 2 3 4 5
Guides the session without relying heavily on
questions
N/A 1 2 3 4 5
Communicates non-verbally through body
language, voice tone, etc.
N/A 1 2 3 4 5
Uses minimal encouragers such as “tell me more”
“go on,” “uh hu,” “head nod,” etc.
N/A 1 2 3 4 5
Asks open-ended questions N/A 1 2 3 4 5
Reflects feelings N/A 1 2 3 4 5
Empathize s- Understand clients’ perspective
without over-identifying with client
N/A 1 2 3 4 5
Reflects meaning N/A 1 2 3 4 5
08/2016 33
Use interventions in a way that is timely and on-
target with the goals of the session
N/A 1 2 3 4 5
Collaborates with clients to set meaningful and
appropriate goals
N/A 1 2 3 4 5
Facilitates movement toward the counseling
goals
N/A 1 2 3 4 5
Keeps accurate and timely records N/A 1 2 3 4 5
Effectively begins a session N/A 1 2 3 4 5
Manages termination of the counseling sessions N/A 1 2 3 4 5
Manages termination of the counseling
relationship
N/A 1 2 3 4 5
Applies forma assessment tools to the counseling
process (e.g. SASSI, BDI, CCAPS, OQ-45)
N/A 1 2 3 4 5
Conceptualization skills
Counselor-in-training is able to:
Identify and consistently demonstrate guiding
theory
N/A 1 2 3 4 5
Demonstrate an understanding of his or her own
cultural worldview or biases and how they might
interface with the counseling process
N/A 1 2 3 4 5
Understand the unique elements of clients’ story N/A 1 2 3 4 5
Recognize implications of culture on the
counseling relationship
N/A 1 2 3 4 5
Respond to cultural differences in a way that is
helpful to the client
N/A 1 2 3 4 5
Professional Demeanor
Counselor-In-Training:
Conducts self ethically and in compliance with
legal requirements
N/A 1 2 3 4 5
Relates to peers appropriately N/A 1 2 3 4 5
Relates to other professionals appropriately N/A 1 2 3 4 5
Seeks out resources that help him or her improve
in-session skills
N/A 1 2 3 4 5
Is aware of his or her levels of wellness or
limitations
N/A 1 2 3 4 5
Practices self-care strategies N/A 1 2 3 4 5
08/2016 34
Recognizes boundaries of competence N/A 1 2 3 4 5
Seeks supervision when necessary N/A 1 2 3 4 5
Responds well to supervision and feedback N/A 1 2 3 4 5
Implements feedback from supervision N/A 1 2 3 4 5
Is able to recognize personal, professional, or
skills deficits that influence their counseling
N/A 1 2 3 4 5
Takes responsibility for deficiencies N/A 1 2 3 4 5
Demonstrates appropriate levels of self-
confidence
N/A 1 2 3 4 5
School Counseling
Counselor-In-Training:
Understands child/adolescent development and
appropriately communicates/intervenes
N/A 1 2 3 4 5
Conducts group counseling effectively N/A 1 2 3 4 5
Conducts guidance lessons effectively N/A 1 2 3 4 5
Conducts individual sessions effectively N/A 1 2 3 4 5
Understands and implements effective
career/college guidance
N/A 1 2 3 4 5
Implements Behavioral Standards and Mindsets
that aligns with the ASCA National Model
N/A 1 2 3 4 5
Applies the school counseling areas of
leadership, advocacy, collaboration, and systemic
change
N/A 1 2 3 4 5
Practices in accordance with the school district
policy, local, state, and federal statutory
requirements
N/A 1 2 3 4 5
Can determine appropriate and useful methods
of collecting school and student data
N/A 1 2 3 4 5
Is able to analyze and interpret data N/A 1 2 3 4 5
Uses data in a meaningful way N/A 1 2 3 4 5
Shares data results with appropriate stakeholders N/A 1 2 3 4 5
Communicates effectively with teachers, parents,
and/or administrators
N/A 1 2 3 4 5
Implements a developmental school counseling
core curriculum addressing all students’ needs
based on student data
N/A 1 2 3 4 5
Demonstrates classroom management and
instructional skills
N/A 1 2 3 4 5
Develops strategies to assess effectiveness of N/A 1 2 3 4 5
08/2016 35
interventions
Develops and/or maintains professional
relationships with school administration and staff
N/A 1 2 3 4 5
Supervisor Comments:
Strengths:
Areas for growth:
Supervisor Signature: __________________________________________________________
Counselor-in-Training Signature: _________________________________________________
University Supervisor Signature: _________________________________________________
08/2016 36
School Counseling Practicum or Internship
University of Northern Iowa
Student Evaluation of Site Supervisor
This evaluation form should be completed by the practicum/internship student at the end of the
practicum/internship experience. Discussion of the form with the site supervisor being evaluated
is encouraged, but not required.
Name of Site Supervisor: _____________________________ Date: _____________
Name of Site: ________________________________________________________________
Name of Student: ________________________________________ Semester/Year: ________
DIRECTIONS: Circle the number which best represents how you, the student, perceived the
supervision received at your site:
Key: 0 – Insufficient opportunity to observe/experience
1 – Needs much improvement 2 – Needs some improvement
3 – Meets expectations 4 – Superior
Note: The words site supervisor through the survey ate interchangeable with faculty
supervisor throughout the survey depending on who you are evaluating.
My site supervisor:
1. Gives time and energy in observing my skills and discussing cases 0 1 2 3 4
2. The site supervisor was friendly and approachable 0 1 2 3 4
3. Accepts and respects me as a person 0 1 2 3 4
4. Recognizes and encourages further development of my strengths &
capabilities
0 1 2 3 4
5. Gives me useful feedback when I do something well 0 1 2 3 4
6. The site supervisor observed my work on a regular basis 0 1 2 3 4
7. Encourages and listens to my ideas and suggestions for developing my
counseling skills
0 1 2 3 4
8. Provides suggestions for developing my counseling skills 0 1 2 3 4
9. Helps me to understand the implications and dynamics of the
counseling approaches I utilize
0 1 2 3 4
10. Encourages me to use new and different techniques when appropriate 0 1 2 3 4
11. The site supervisor demonstrated multicultural competencies 0 1 2 3 4
12. Helps me to define and achieve specific concrete goals for myself
during the practicum/internship experience
0 1 2 3 4
08/2016 37
13. Gives me useful feedback when I do something inappropriate 0 1 2 3 4
14. Allows me to discuss problems I encounter in my practicum/internship
setting
0 1 2 3 4
15. Focuses on both verbal and nonverbal behavior in me and in my
clients
0 1 2 3 4
16. Helps me define and maintain ethical behavior in counseling and case
management
0 1 2 3 4
17. Encourages me to engage in professional behavior 0 1 2 3 4
18. Maintains confidentiality in material discussed in supervisory sessions 0 1 2 3 4
19. Deals with both content and affect when supervising 0 1 2 3 4
20. Focuses on the implications, consequences, and contingencies of
specific behaviors in counseling and supervision
0 1 2 3 4
21. Helps me organize relevant case data in planning goals and strategies
with my client
0 1 2 3 4
22. Helps me to articulate my theoretical orientation 0 1 2 3 4
23. Offers resource information when I request or need it 0 1 2 3 4
24. Helps me develop increased skill in critiquing and gaining insight
from my counseling tapes/or receiving feedback from live supervision
0 1 2 3 4
25. Allows and encourages me to evaluate myself 0 1 2 3 4
26. Explains his/her criteria for evaluation clearly 0 1 2 3 4
27. Applies his/her criteria fairly in evaluating my counseling
performance
0 1 2 3 4
28. The site supervisor was a good liaison to the counseling profession 0 1 2 3 4
29. The site supervisor informed me about professional growth
opportunities that would enhance my learning
0 1 2 3 4
30. Did your site placement meet your expectations 0 1 2 3 4
31. Did your site placement broaden your understanding of the counseling
field and diverse client populations
0 1 2 3 4
32. Do you believe your site placement enhanced your counseling skills
and professional growth
0 1 2 3 4
33. Would you recommend this supervisor for other students in our
program
0 1 2 3 4
Additional Comments and/or Suggestions:
Student’s Signature: ___________________________________________ Date: ____________
08/2016 38
School Counseling Practicum or Internship
University of Northern Iowa
Student Evaluation of Faculty Supervisor
This evaluation form should be completed by the practicum/internship student at the end of the
practicum/internship experience. Discussion of the form with the faculty supervisor being
evaluated is encouraged, but not required.
Name of Faculty Supervisor: _____________________________ Date: _____________
Name of Site: ________________________________________________________________
Name of Student: ________________________________________ Semester/Year: ________
DIRECTIONS: Circle the number which best represents how you, the student, perceived the
supervision received in your program:
Key: 0 – Insufficient opportunity to observe/experience
1 – Needs much improvement 2 – Needs some improvement
3 – Meets expectations 4 – Superior
Note: The words site supervisor through the survey ate interchangeable with faculty
supervisor throughout the survey depending on who you are evaluating.
My faculty supervisor:
34. Gives time and energy in observing my skills and discussing cases 0 1 2 3 4
35. The site supervisor was friendly and approachable 0 1 2 3 4
36. Accepts and respects me as a person 0 1 2 3 4
37. Recognizes and encourages further development of my strengths &
capabilities
0 1 2 3 4
38. Gives me useful feedback when I do something well 0 1 2 3 4
39. The site supervisor observed my work on a regular basis 0 1 2 3 4
40. Encourages and listens to my ideas and suggestions for developing my
counseling skills
0 1 2 3 4
41. Provides suggestions for developing my counseling skills 0 1 2 3 4
42. Helps me to understand the implications and dynamics of the
counseling approaches I utilize
0 1 2 3 4
43. Encourages me to use new and different techniques when appropriate 0 1 2 3 4
44. The site supervisor demonstrated multicultural competencies 0 1 2 3 4
45. Helps me to define and achieve specific concrete goals for myself
during the practicum/internship experience
0 1 2 3 4
08/2016 39
46. Gives me useful feedback when I do something inappropriate 0 1 2 3 4
47. Allows me to discuss problems I encounter in my practicum/internship
setting
0 1 2 3 4
48. Focuses on both verbal and nonverbal behavior in me and in my
clients
0 1 2 3 4
49. Helps me define and maintain ethical behavior in counseling and case
management
0 1 2 3 4
50. Encourages me to engage in professional behavior 0 1 2 3 4
51. Maintains confidentiality in material discussed in supervisory sessions 0 1 2 3 4
52. Deals with both content and affect when supervising 0 1 2 3 4
53. Focuses on the implications, consequences, and contingencies of
specific behaviors in counseling and supervision
0 1 2 3 4
54. Helps me organize relevant case data in planning goals and strategies
with my client
0 1 2 3 4
55. Helps me to articulate my theoretical orientation 0 1 2 3 4
56. Offers resource information when I request or need it 0 1 2 3 4
57. Helps me develop increased skill in critiquing and gaining insight
from my counseling tapes/or receiving feedback from live supervision
0 1 2 3 4
58. Allows and encourages me to evaluate myself 0 1 2 3 4
59. Explains his/her criteria for evaluation clearly 0 1 2 3 4
60. Applies his/her criteria fairly in evaluating my counseling
performance
0 1 2 3 4
61. The site supervisor was a good liaison to the counseling profession 0 1 2 3 4
62. The site supervisor informed me about professional growth
opportunities that would enhance my learning
0 1 2 3 4
63. Did your site placement meet your expectations 0 1 2 3 4
64. Did your site placement broaden your understanding of the counseling
field and diverse client populations
0 1 2 3 4
65. Do you believe your site placement enhanced your counseling skills
and professional growth
0 1 2 3 4
66. Would you recommend this supervisor for other students in our
program
0 1 2 3 4
Additional Comments and/or Suggestions:
Student’s Signature: ___________________________________________ Date: ____________
08/2016 40
School Counseling Practicum or Internship
University of Northern Iowa
Site Supervisors’ Evaluation of Program
Date: _________________
Semester: ___Fall ___Spring
___School Counseling Supervisor ___Clinical Mental Health Supervisor
__Practicum ___Internship
Optional: Site_____________________
Dear onsite supervisor:
We value the services that you provide to the school and clinical mental health counseling
programs at the University of Northern Iowa and we are very interested in obtaining your
feedback in order to improve the quality of our program. Your experiences as a Practicum and/or
Internship supervisor are very valuable to us. Thanks!
Please respond on a scale of:
1 = poor
2 = fair
3 = average
4 = above average
5 = excellent
08/2016 41
Students’ Preparation and Training
1. Compared to other master’s degree level students, UNI students overall educational
preparation is:
1……………...2………………3……………….4………………5
2. Student’s counseling skills abilities:
1……………...2………………3……………….4………………5 N/A
3. Student’s case conceptualization skills:
1……………...2………………3……………….4………………5 N/A
4. Student’s ethical behavior:
1……………...2………………3……………….4………………5 N/A
5. Student’s theoretical knowledge:
1……………...2………………3……………….4………………5 N/A
6. Student’s administrative skills:
08/2016 42
1……………...2………………3……………….4………………5 N/A
Facilitation of Supervision and Program’s Feedback
7. Supervisor’s perception of support from UNI faculty and administrative personnel:
1……………...2………………3……………….4………………5 N/A
8. I am able to communicate frequently with the Practicum/Internship faculty supervisor:
1……………...2………………3……………….4………………5 N/A
9. My feedback and suggestions are heard by the UNI program:
1……………...2………………3……………….4………………5 N/A
10. The program uses technology efficiently to enhance supervision and communication
processes:
1……………...2………………3……………….4………………5 N/A
11. The program offers me the opportunity to learn about supervision processes:
08/2016 43
1……………...2………………3……………….4………………5 N/A
12. The following suggestions should be considered for program improvement:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________