instructions for completing the yu-practicum placement … · 2020. 12. 9. · practicum approval...

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MACP 3.0 Revised November 2020

Instructions for Completing the YU-Practicum Placement Application (Page 1 of 3) (do not include these pages in your application package)

This package was created as a PDF document to ensure that it is easy to complete electronically while important legal information and contracts remain locked. Please ensure all student and supervisor forms’ responses are typed. Only typed forms will be accepted. Also, please ensure all student, supervisor(s) and witness signatures are handwritten or digital signatures. The student’s name must be typed on every page. Applications submitted or completed incorrectly will not be processed.

o February 1 for May practicum course startso June 1 for September practicum course startso October 1 for January practicum course starts

1. Students are responsible for ensuring that each form is filled out correctly.

2. No photos of documents or forms will be accepted. Please ensure that your documents are properly formatted.

3. Carefully review the most current version of the Practicum Portal for information about all current practicum requirements before completing your application.

4. Start preparing your application package as early as possible in the term before your practicum. You need to collect a great deal of information, including documents and signed pages from your site supervisor(s).

5. Fill in your personal information in each section that requests it. Type directly on the form. If for any reason you run out of space, simply type the additional information into a new document and include it in the proper place in your Practicum Application.

6. Make sure you ask your site supervisor(s) as early as possible whether a Criminal Record Check (CRC), records of immunizations, and or mask fittings are required by your site. If you need to acquire any of these, start the process of acquiring them early so you will have the necessary documents in time to meet the application deadline. See IMPORTANT ADDITIONAL NOTES below about immunization records, mask fittings for hospital settings, and CRC.

7. Send the sections of the package your supervisor(s) needs to complete to him or her along with a list of other documents you will need from him/her/them, and inform your supervisor of the date that you need everything sent back to you. Make sure you give yourself enough time before the deadline to be able to review what has been sent back to you for accuracy and completeness. See IMPORTANT ADDITIONAL NOTES below about what documents must be submitted if you will have two supervisors (co-supervisors) at the same site.

8. Before submitting your YU-Practicum Placement Application you must review your site supervisor’s sections of the package after they have been returned to you to verify they are complete (e.g., all appropriate boxes checked off and all signatures are included where required, etc.). If there are boxes left unchecked or signatures missing, you must go back to the site supervisor to obtain the information needed for completion. An incomplete application will delay the approval process.

9. After your site supervisor(s) has completed and signed all his/her/their required sections of the package and you have obtained all additional documents if applicable, scan them as one document in the order on the Application Cover Sheet and save the scanned document as a PDF on your computer. The complete application must be uploaded as a PDF and as one document. If you are unable to scan the package as one document on your own computer, you are responsible for finding a way to ensure this is done (e.g., finding a store or office that offers such services or using a friend’s computer, etc.). Applications submitted in any other format than PDF will not be processed for approval. Please make sure all pages of the application package are oriented in the same direction and assembled in the order noted on the Application Cover Sheet.

10. Please use the provided Application Cover Sheet to make sure you have included all of the required documents in the correct order (See IMPORTANT ADDITIONAL NOTES on the next page). Failure to submit your Practicum Placement Application without all of the required documentation will result in it being returned to you to be completed and resubmitted. If a YU-Practicum Placement Application has to be resubmitted, it will go to the bottom of the applications waiting to be reviewed. This will delay the practicum approval and may result in your application not being approved in time to begin your practicum, with the practicum having to be put on hold until the next trimester.

11. The YU-Practicum Placement Application must be uploaded by 11:55pm Atlantic Time on the date of the submission deadline. Any application packages not submitted by the deadline will not be processed for approval. Submission deadlines for practicum applications are:In place of employment: All regular applications:

o March 1 for May practicum course startso July 1 for September practicum course startso November 1 for January practicum course starts

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Instructions for Completing the YU-Practicum Placement Application (Page 2 of 3)

IMPORTANT ADDITIONAL NOTES

Additional Required Documents Because it is the university’s responsibility to ensure students have acquired a record of all the required documentation (including but not limited to immunizations, mask fittings, and criminal record checks (CRC) with vulnerable sector screening), students must submit proof of required documents as part of their YU-Practicum Placement Application if the site and or supervisor indicate on the Practicum Agency/ Site Information form that additional documents are required. Failure to submit necessary additional documents will delay the processing of a student’s application and may impact whether the student will be able to begin practicum on time, or whether the practicum will be deferred to the next trimester. It is important for students to understand these requirements are driven by the site’s policies and procedures. If any requirements are not met it will be the site’s decision to cancel the student’s practicum.

Immunization records Students should be aware if they are planning to complete their practicum within a health authority, for example a hospital, nursing home, rehabilitation centre or other health facility, they will be required to provide up-to-date records of immunizations (including measles, mumps, rubella (MMR) and TB skin test results. It is recommended students begin the process of accumulating these records as soon as they begin applying for a practicum placement in a health authority setting. If students have any questions about what immunizations they will require, they should contact their practicum site.

Mask fittings for hospital settings Students should be aware if they are planning to complete their practicum within a hospital setting they may be required to have a respiratory mask fitting prior to beginning practicum. It is recommended that students begin this process as soon as they know they will be completing a practicum placement in a hospital setting. If students have any questions about mask fittings, they should contact their practicum site.

Criminal record check (CRC) It is very important that all students confirm with their proposed practicum site as soon as possible whether a CRC is required and if they must also acquire a Vulnerable Sector Check in addition to a regular CRC. Please ensure that you begin this process early, so you will obtain all of the necessary documents prior to submitting your YU-Practicum Practicum Application . Proof of a criminal record check currently in progress (eg. a receipt) will be accepted for PPA review purposes, but a complete criminal record check must be submitted to [email protected] before you start practicum.

Additional documents not mentioned: Some health authorities or sites may have additional requirements not listed above (e.g. Oath of Confidentiality, online training modules, etc.) These documents must also be included in your YU-Practicum Placement Application. Inquire with your site early as to whether any additional documents are required before starting practicum. There is a space allotted for extra required documents on the Application Cover Sheet.

Co-supervisors at one site If a student has two supervisors (co-supervisors) at one site each supervisor must do the following:

• Review and sign Workplace Practicum form (if applicable)• Sign the Practicum Agency/Site Information form• Complete a Practicum Supervisor Information form• Sign the Practicum Terms of Agreement (for Supervisor)• Sign the Acknowledgement of Supervisor and Supervision Requirements form• Provide student with an up-to-date copy of his/her/their Curriculum Vitae (CV) or résumé• Provide student with proof of professional association membership, registration or license

Include all documents for both supervisors in one complete YU-Practicum Placement Application document in the order identified on the Application Cover Sheet under Supervisor Sections. Please have supervisor-specific documents arranged by supervisor (i.e. all forms, resume, and proof of registration for the first supervisor, followed by all forms, resume, and proof of registration for the second supervisor). There is no need to include duplicates of any of the forms in Student Sections or Additional Documents. Only ONE copy of the Practicum Agency/ Site Information form and ONE copy of the Acknowledgement of Supervisor and Supervision Requirements form should be included.


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Instructions for Completing the Practicum Placement Application (PPA) (Page 3 of 3)

Supervisor’s curriculum vitae (CV)/ résumé All proposed practicum supervisors must provide students with an up-to date CV or résumé to submit with the student’s YU-PPA even if the supervisor has supervised for Yorkville previously. Please note that supervisor CV’s and résumés should be in English, and in chronological order specifying education and employment in months and years including part-time and full-time employment.

Proof of professional association membership, or college registration or license For those supervisors who are members or registrants of a professional counsellor, psychologist or social worker association or college, proof of professional association membership, college registration or license can be in the form of a copy of membership card (including expiry date), a letter of confirmation of membership, registration or license from the professional association or college, and/or a dated copy of the relevant page of the professional association or college’s online registration list identifying the supervisor as a member in good standing. In cases where licensure doesn’t apply, the practitioner’s Curriculum Vitae (CV) or résumé would be expected to show relevant experience and membership in appropriate professional societies. Transcripts and proof of degree may also be requested.

Note: If your Practicum is taking place in Ontario, your supervisor will also need to complete Appendix D: CRPO Attestation. Students must then include the completed Appendix D form in their Practicum Placement Application.

Insurance coverage

Liability insurance: All Yorkville University students in Canada are covered by Yorkville University's liability insurance for the duration of the practicum. If the proposed practicum site needs a copy of the insurance certificate, it can be obtained by contacting the Department of Field Training at [email protected]. This document does not need to be included in the YU-Practicum Placement Application. Please note that insurance certificates are not provided to students; the proposed practicum supervisor must request a copy of the certificate.

Students completing their practicum outside of Canada are not covered by the university’s liability insurance and must complete and submit with the PPA the Acknowledgement and Release of Yorkville University Responsibility form.

Workplace accident insurance: Yorkville University carries an insurance policy which covers students that incur accidental injuries while on practicum placement. The university does not warrant the adequacy or appropriateness of this coverage. Students and or practicum site supervisors are welcome to examine the details of this coverage to determine if it is adequate and appropriate for their particular circumstances. If the proposed practicum site needs a copy of the insurance certificate or details of the insurance coverage it can be obtained by contacting the Department of Field Training at [email protected]. This document does not need to be included in the Practicum Placement Application.

Affiliation agreements Many practicum sites, in particular hospitals, school boards and government departments, require an affiliation agreement, which is a contract between the practicum site and the university. Please make sure you ask your proposed practicum supervisor as early as possible about any additional agreements or contracts that must be completed before you begin your practicum. Your supervisor may need to check with the Director of the agency, or the Human Resources (HR) department or some other personnel within the organization before they can give you an answer, so keep this in mind and ask the question as early as possible. Getting a response will likely take time. Yorkville University may already have an affiliation agreement in place with the practicum site or have had one in the past that could be out of date or may expire during your practicum. It is your responsibility to ask whether such an agreement is required and, if so, to let the Department of Field Training know. If one is needed, please contact the Department of Field Training at [email protected].

It can often take months for an affiliation agreement to be put in place, as it usually involves several officials within the practicum organization and the university to negotiate and sign an affiliation agreement. It is important for you to know, in some cases, we are not able to negotiate a mutually acceptable agreement with a site, and, therefore, it is important for you to have a back-up plan in place in case it is needed. If you have any questions about this, please contact the Department of Field Training at [email protected].


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Application Cover Sheet

Read “Instructions for Completing the Practicum Placement Application” before completing the checklist below.

Once each item on this cover sheet has been completed, indicate this below by marking the box with an “x.” Include this cover sheet as page one of your application. Mark N/A (Not Applicable) for any documents that do not apply to your situation.

IMPORTANT: All required documents must be included in your application in the order listed on this cover sheet and uploaded as one document or your application package will not be processed.

Student Sections Application Cover Sheet

Practicum Student Information

For practicum in place of employment only

Workplace Practicum (3 pages) [Must be reviewed and hand signed by practicum supervisor(s).]

Organizational Chart (See instructions on the bottom of page 2 of Workplace Practicum form)

Student’s Education / Professional Development / Employment / Volunteer History (2 pages)

Employment / Practicum / Life Balance Schedule

Practicum Terms of Agreement (for Student)

Ethical Guidelines

Pledge of Confidentiality

For practicum outside of Canada only

Acknowledgement and Release of Yorkville University Responsibility

Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisor

Practicum Agency / Site Information (2 pages)

Practicum Supervisor Information (2 pages)

Proof of Current Professional Association Membership, College Registration or License

Curriculum Vitae (CV) / Résumé

Practicum Terms of Agreement (for Supervisor) (2 pages)

Acknowledgement of Supervisor and Supervision Requirements

For Ontario supervisors only CRPO Attestation

Additional Documents Only if Required by Site (as Identified on Page 2 of Site Information Forms) Follow directives in IMPORTANT ADDITIONAL NOTES

Criminal Record Check

Immunization Records

Proof of Mask Fitting

Additional Documents (please note):

Typed name of student MACP 3.0 Revised November 2020

For students providing any services online Tele-Mental Health Counselling Request Form

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Practicum Student Information

Personal Contact Information

First Name: Last Name: Student #:

Address: City: Province: Country:

Email: Phone: Postal Code:

When will your last MACP academic course be completed?

Have you previously had to put your placement on hold? Yes No If yes, for how many trimesters?

Make Yourself Aware Please initial beside each practicum guideline. Typed or handwritten initials are acceptable.

I am aware that I am required to have a minimum of 400 total practicum hours.

I am aware that of the 400 total practicum hours 200 of them must be direct client contact hours.

I am aware that of the 200 direct client contact hours 120 of them must be direct mental health counselling.

I am aware that at this stage of my training the majority of the 120 direct counselling hours should involve individual therapy.

I am aware that students are no longer required to complete group therapy hours. If my site and I decide that group therapy will be incorporated into my practicum, I am aware that psycho-social, psycho-education services, career, vocational, academic counselling, and support group services do not fulfill the requirements for group therapy. It must be group mental health counselling.

I am aware that in addition to all course assignments in PSYC7113, I must complete approximately 30 percent of the required direct client contact hours (60 hours) to receive a passing grade for PSYC7113 and to proceed to PSYC7203.

I am aware that in in order for me to obtain my required direct client contact hours by the end of my practicum I should average six or seven hours of direct client contact hours per week.

I am aware that in order for me to obtain my required direct counselling hours by the end of my practicum I should average four hours of direct counselling per week.

I am aware that indirect client contact, such as reviewing case files, session preparation, case notes and maintaining case files, formal report writing, case consults, and research and reading can take as much time per week as direct client contact hours.

I am aware that I must have a minimum of one hour of face to face supervision with my site supervisor per 13.5-hour week.

I am aware that some sites may require me to engage in valuable activities (e.g., attending staff meetings, symposiums, training, workshops, etc.) that may take time away from the 13.5 hours per week I will need to obtain my direct client contact hours, which may require me to devote more than 13.5 hours per week toward practicum.

I am aware that some sites may require me to find my own clients, and that these sites will not be approved as a viable practicum.

Practicum Duration

All practicum plans must cover two full trimesters. All students are required to remain on-site until their last seminar (the last week of the trimester). Please specify your practicum start and end dates.

Start date: End date: Month / Day / Year Month / Day / Year

Typed name of student

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Student’s Education / Professional Development / Employment / Volunteer History (page 1 of 2)

Please read and fill out carefully, including specializations and dates where applicable. If specific dates are not available, providing month and year will suffice. Workshops must include an end date, even if the training was one day only. Do not include the MACP under education history.

Relevant Education History There is no need to include MACP in progress.

Post-Secondary Education (Degrees, Diplomas & Certificates) –

INCLUDE MAJOR OR SPECIALIZATION (common abbreviations acceptable)

Educational Institution or Organization

Start Date (M / D/ Y)

End Date (M / D / Y)

Relevant Professional Development History

Workshops / Training Educational Institution or Organization

Start Date (M / D/ Y)




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Student’s Education / Professional Development / Employment / Volunteer History (page 2 of 2)

Employment History (all)

Name of Place of Employment

Position / Title

Avg. Hours

Worked / Week

Start Date (M / D / Y)


Duties

Relevant Volunteer History

Name of Place Where Volunteered

Position / Title

Avg. Hours

Volunteered / Week

Start Date (M / D / Y)


Duties



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Employment / Practicum / Life Balance Schedule

Onsite practicum hours are to be determined through consultation with the practicum supervisor. If weekend and/or evening hours will be required by the site, please ensure you indicate this below.

Please fill in the boxes on the schedule below, using ONLY the letters (E) for employment hours, (C) for practicum course work hours (approximately 10 – 15 hours per week), and (P) for onsite practicum hours (minimum of 13.5 hours per week). Please do not include any other information, letters, or details.

When scheduling onsite practicum hours, you must ensure these are in no less than three- or four-hour blocks of time, to optimize your learning experience.

While we are not asking you to fill in when you will be engaging in self-care and family time activities, it is assumed that you will incorporate a healthy balance of these activities into your weekly schedule.

Weekly schedule during practicum

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

7:00am - 8:00am

8:00am - 9:00am

9:00am - 10:00am

10:00am -11:00am

11:00am – 12:00pm

12:00pm – 1:00pm

1:00pm – 2:00pm

2:00pm – 3:00pm

3:00pm – 4:00pm

4:00pm - 5:00pm

5:00pm - 6:00pm

6:00pm – 7:00pm

7:00pm - 8:00pm

8:00pm – 9:00pm

Indicate how many hours per day you will allocate to each category. (Please double-check your addition.) TOTAL / WEEK

Total employment hours Total practicum course work hours Total onsite practicum hours



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Practicum Terms of Agreement (for Student)

All students must read and sign the following Practicum Terms of Agreement:

• I understand that in order to continue in my practicum placement, I am expected to conduct myself in a professional manner at all times.

• I understand that I am eligible to begin my practicum after I have successfully completed all academic coursework, and I must be in good standing academically (GPA 3.0).

• I understand that before I can begin my practicum I must be in good standing with the university Bursar. (To be in good standing with the Bursar prior to starting your practicum means that you must pay any and all outstanding fees owing to the university and pay applicable Practicum course fees in full.) Failure to meet this obligation prior to my practicum start date will result in me having to postpone my practicum.

• I understand it is a privilege for me to be accepted as a practicum student. I agree to abide by all policies and procedures established by the agency or institution.

• I agree to accept supervision from the approved site supervisor(s) and I am prepared to accept responsibility for attending supervisory meetings with my supervisor(s) in accordance with this practicum agreement and the requirement of the practicum courses.

• I agree to give consent for my faculty instructor, site supervisor, practicum coordinator, and other university staff to share information regarding my practicum performance throughout the duration of my practicum, as necessary.

• I agree to inform my site supervisor, faculty instructor, and my practicum coordinator of any change in my work setting or job assignment, or if any unforeseen issues arise which may affect my ability to complete my practicum requirements as specified in the most current version of the Practicum Portal.

• I understand I must engage in a practicum where at least 50 percent of my sessions with clients must be conducted in English.

• I understand all video and or audio tape recordings used for faculty instruction must be in English.

• I understand the length of the practicum is two full trimesters (30 – 33 weeks), and, if my practicum extends beyond 35 weeks, I may be charged an additional fee as determined by the Bursar’s Office.

• I understand I must complete approximately 30 percent of the required direct client contact hours (60 hours) to receive a passing grade for PSYC7113 and to proceed to PSYC7203.

• I have read the most recent version of the Practicum Portal.

I have read and understand these Practicum Terms of Agreement (for Student).

Typed Name of Student Date: Month/ Day/ Year

Signature of Student

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Ethical Guidelines

Students must conduct themselves in an ethical and professional manner at all times when interacting with Yorkville University staff, clients, site supervisors, agency staff, faculty instructors, colleagues and fellow students. They are also expected to be familiar with current ethical guidelines of their professional counselling associations as well as the provincial laws related to the practice of counselling in their jurisdiction and specific to the site. If no laws or professional counselling associations exist, then students will follow the ethical guidelines of the practicum site. If the practicum site does not have formally stated ethical guidelines to govern their day-to-day practice with clients, students should follow the Canadian Counselling and Psychotherapy Association (CCPA) ethical guidelines. When students have questions or concerns about potential legal and ethical issues, they should discuss these matters with their site supervisor and faculty instructor. Students agree to abide by these standards, including, but not limited to, the areas below:

1. Recognition of student’s status and limitations: Before initiating counselling services, students will disclose to clients their status as practicum students. Students recognize the limits of their current skills and competencies, and practice only within the boundaries of their competence. When clinical situations are beyondtheir knowledge or abilities, students will immediately seek supervision to discuss the issues with their site supervisor and facultyinstructor.

2. Safe and effective use of self:Practicum students must engage in safe and effective use of self at all times. Students monitor their own well-being and refrain fromproviding direct counselling services when their physical, mental, or emotional problems may prevent them from effectively workingwith clients. Students must notify their site supervisor and faculty instructor immediately when they are aware of personal issues thatimpact their practice, and seek appropriate professional services as needed.

Prior to practicum, students are encouraged to disclose and discuss with their site supervisor(s) and faculty instructor any medical or personal history that may potentially cause triggers while seeing clients or interfere with their ability to work with clients during their practicum. If either the site supervisor or the faculty instructor recommends the student seek additional professional help (e.g.,counseling), students are strongly encouraged to follow their supervisor’s directions.

3. Dual relationships: In the counselling profession, a dual relationship refers to any situation where multiple roles exist between a therapist or counsellortrainee and a client. Examples of dual relationships are when the client is also a student, friend, family member, co-worker, employee,business associate of the therapist or the spouse, parent, or sibling of an existing client. Counsellors make every effort to avoid dualrelationships with clients that could impair their professional judgment or increase the risk of harm or unethical treatment of clients.When a dual relationship cannot be avoided (such as in a small remote community), counsellors take appropriate professionalprecautions such as role clarification, informed consent, consultation, and documentation to ensure that judgment is not impaired and no exploitation occurs. If the potential for a dual relationship arises, students must immediately discuss the situation with their sitesupervisor and or faculty instructor.

In addition, practicum students cannot be supervised by their former or current therapist or by anyone who has served, or currently serves, as an employment manager or supervisor, co-worker, educator, mentor or anyone who has any direct reporting alignment at the student’s place of employment. Also, students must not enter into a supervisory relationship with a family member and or friend.

During the course of supervision, a student may disclose to a site supervisor that he/she/they is (are) experiencing some significant personal issues as a result of his/her/their experiences with clients. While this may be a normal and important part of supervision to disclose such personal issues to the site supervisor, it is important that the student and the supervisor do not engage in a therapeutic relationship. In such cases, where significant personal issues do arise for students, it is appropriate and necessary for the site supervisor to refer the student to another independent counselling source.

Students must not develop sexual, romantic or intimate interactions or relationships with their clients, past or present.

4. Ethics discussion with supervisor:At the beginning of the practicum placement, students will discuss with their site supervisor the ethical guidelines, provincial laws and regulations and the professional standards of practice maintained by the practicum site.

I have read and understand these Ethical Guidelines.




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Pledge of Confidentiality

I, (Name of student), do solemnly and sincerely affirm that I will keep all information disclosed by clients or learned or observed about clients strictly confidential. I will not share any client information whatsoever with any unauthorized person and I will keep any and all files, records and notes pertaining to clients in a secure place to which no unauthorized persons have access.

I further agree to abide by the confidentiality policies of the practicum site at which I will be training. I will also advise clients of any and all limits to confidentiality that may be imposed by any law, regulation or policy before the client discusses any matter with me.

I understand that as part of my practicum experience, I must present, to my faculty instructor and my classmates in the practicum courses, two video or audio recordings and complete several written or verbal presentations related to the counselling sessions I conduct. In order to participate in these activities, I must adhere to the following terms:

• To protect the confidentially of the client, when recording video sessions, students must set up the recordingequipment so that it is focused on only the counsellor and not the client and they must also take every precautionnot to use the client’s full name while recording the sessions. Students are responsible for the security of allrecordings and must take every precaution that the recording is kept in a secure location, such as a locked filingcabinet in a locked room, or, if it is stored on a computer, it must be protected with a password that only thestudent has access to.

• Students are responsible for making arrangements for all necessary recording equipment if the practicum site doesnot own, or have access to, such equipment. Students may use a laptop, tablet or smart phone with video recordingcapabilities; however, students must make sure they take every security precaution necessary to protect theconfidentiality of the client.

• All recorded sessions must be permanently deleted or erased after the faculty instructor has completedhis/her/their review.

• When completing any written or verbal assignments students must ensure any and all client identifyinginformation is kept confidential.

I will review this Pledge of Confidentiality with my site supervisor(s).



Declaration of Witness (Must be signed by an individual over the age of majority, which may vary according to jurisdiction):

I, (Name of witness), declare that I was personally present when the above-named student read and signed this pledge of confidentiality.

Typed Name of Witness Date: Month/ Day/ Year

Handwritten Signature of Witness

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Practicum Agency/Site Information (Page 1 of 2)This form must be completed by the proposed practicum supervisor(s). Please ensure all forms are typed.

Site Contact Information Name of Proposed Site: Phone Number:

Address: City: Province: Country:

Website: Postal Code:

Name of Parent Organization if applicable (e.g., Alberta Health Services, Ministry of Child and Family Development, School Board or District, etc.):

Approved agencies may choose to be listed on Yorkville University’s list of potential practicum sites to be approached by other students seeking a practicum placement. Does your agency wish to be included on Yorkville University’s list of potential practicum sites?

Yes No

If yes to above question, please provide the name and contact information of the official contact person whom future students should contact regarding applying for a practicum at the agency (e.g., Executive Director, Field Placement Coordinator, etc.).

Name: Position/Title:

Phone: Email:

Type of Agency (Check as many as apply) Child Guidance Clinic Private Practice Schools

Community Mental Health Department/School Clinic University Counsel/Student Mental Health Medical Clinic/Hospital Forensic/Justice (Jail) Inpatient Psychiatric Hospital

Outpatient Psychiatric Clinic/Hospital Partial Hospitalization/Intensive Outpatient Program Residential/Group Home

VA Medical Center Other Please Specify: Client Population Served (Check as many as apply)

Family Women Youth LGBTQ+ Military Children Men Other Please Specify:

Which of these service provision areas will the student receive experience in during his/her/their practicum? (Check as many as apply)

Addictions Services Couples/Marriage Therapy Group Therapy Anger Management Eating Disorders Therapy Individual Therapy Assessments Family Therapy Psychiatric Mental Health Counselling Bereavement/Grief Counselling General Mental Health Counselling Trauma Counselling Please Specify: Other Please Specify:


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Practicum Agency/Site Information (Page 2 of 2)

Typed Name of Supervisor Date: Month/ Day/ Year

Signature of Supervisor

Typed Name of Second Supervisor (if applicable) Date: Month/Day/Year

Signature of Second Supervisor (if applicable)

I am aware of all pre-practicum requirements at my site, including but not limited to: mask fitting, immunizations, and criminal record checks.



Please indicate what theory or theories of practice the student will be expected to practice with your clients at this site. (For example: Cognitive Behavioural Therapy, Narrative Therapy, Solution Focused Therapy, Rogerian Therapy, Adlerian Therapy, etc.)

To be appropriately assessed by the faculty Yorkville University students and clients must be able to conduct client sessions in English. It is agreed that at least 50 percent of the student’s sessions with clients at this site will be conducted in English.

Yes No

As part of the requirements for successful completion of the practicum, Yorkville University students must be able to present three video recordings of live client sessions during faculty instruction. Please indicate whether your site’s policy (or affiliation agreement with Yorkville University) will permit this.

Yes No

If video recording is not allowed, will the student be allowed to present three audio recordings of live client sessions? Yes No

If neither video nor audio is allowed, the supervisor agrees to help develop a mock session according to the terms described in the Supervisor’s Agreement and the Practicum Portal Yes No

Does the practicum site require the practicum student to have any immunizations before starting practicum? Yes No

Does the practicum site require the practicum student to have a mask fitting before starting practicum? Yes No

Does the practicum site require the practicum student to have a criminal record check? Yes No

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Practicum Supervisor Information (Page 1 of 2)

If you will have more than one supervisor, each one must complete a separate copy of this form. Please ensure you provide each supervisor with his/her/their own copy of this form for completion. Please ensure all forms are typed.

Supervisor Contact Information

Dr. Mr. Ms. First Name: Last Name:

Work Address: City: Province: Country:

Email: Work Phone: Postal Code:

Position / Title:

Professional Association / Affiliation

Counsellor Social Worker Psychologist Other Name of Professional Association: PLEASE NOTE: All supervisors must provide the student with proof of their current professional association membership, registration, or license to submit with the YU-Practicum Placement Application. Proof of professional association membership, college registration or license can be in the form of a copy of membership card (including expiry date), a letter of confirmation of membership, registration or license from the professional association or college, and or a dated copy of the relevant page of the professional association or college’s online registration list identifying the supervisor as a member in good standing. Additionally, for Ontario placements, supervisors must provide the student with a completed copy of Yorkville’s CRPO Attestation form (Appendix D).

If professional association membership, registration, or license is not required in your jurisdiction or by your employer, please indicate the Code of Ethics under which you practice.

Code of Ethics:

Clinical Supervision Information

Below, please briefly describe your clinical experience and background in clinical supervision (e.g., trained in supervision, new experience, supervising for “x” number of years, etc.)

Years of clinical counselling experience:

Highest degree in clinical counselling/psychology/social work and year obtained:

Do you have one full year of clinically- supervised experience post degree? Yes: No:

Years of experience in providing clinical supervision:

Applicable training in supervision (note course names, etc. as applicable):

Other notable information:


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Practicum Supervisor Information (Page 2 of 2)

Yorkville University uses the following categories to identify the site supervisor’s role in the student’s practicum. • Primary Supervisor: One supervisor with full credentials who will take full responsibility for the clinical supervision of the practicum

student;• Co-supervisors: Two supervisors with full credentials who will share the clinical supervision of the practicum student;• Onsite Supervisor: Supervisor who works at the agency and will provide clinical supervision onsite at the practicum agency; and• External Supervisor: Supervisor who works externally to the practicum agency and will provide clinical supervision of the student, as per

the Practicum Terms of Agreement (for Supervisor). External supervisors must have an onsite contact person whom they can contact toobtain regular weekly or bi-weekly updates on the student’s day to day onsite performance.

What supervisory role will you play in this practicum? Primary Supervisor Co-supervisor

Will you be an onsite or external supervisor? Onsite External

If you are an external supervisor, please identify the person onsite with whom you will have regular weekly or bi-weekly contact.

Name: Position /Title:

Email: Phone:

Yes No


Will you be supervising more than one Yorkville University student concurrently?

N


Practicum Terms of Agreement (for Supervisor) (Page 1 of 2)

If you have more than one supervisor, each one must read and sign this document.

All supervisors must read and sign the following Practicum Terms of Agreement (for Supervisor):

• I understand the practicum student I will be supervising is a student in the Master of Arts in Counselling Psychologyprogram at Yorkville University and I am prepared to act in the capacity of clinical supervisor during the perioddesignated by the university.

• I do not have any previous or current professional relationship with this student, such as a therapist, co-worker, educator,mentor, manager, or supervisor. Nor do I have a personal relationship, such as familial or friendship, with this student.

• I am prepared to supervise and appraise the student in the practice of counselling in my work setting or at the designatedpracticum site, and will follow the Code of Ethics of my regulatory body or professional association when doing so. If I amnot registered, I have indicated which Code of Ethics I will follow on the Practicum Supervisor Information forms.

• I agree to accept professional and tutorial responsibility for the practicum student and I will review the work of thestudent on a regular basis, providing at least one hour of direct, face-to-face, individual supervision per 13.5-hour week (an

average of one hour of supervision per every five to six hours of direct client contact). In the case of an external supervisor, in addition to providing one hour per week of face-to-face supervision to the student, the supervisor must take the time necessary to become familiar with the practicum site and ensure regular weekly or bi-weekly contact with a designated person on site (e.g. executive director or client service manager, etc.) to review the student’s onsite performance. Also, external site supervisors must make a minimum of three site visits during the course of the practicum (e.g., one at beginning, mid-point, and end of practicum).

• I agree to directly observe at least three of the student’s one-on-one client sessions in full and provide feedback and guidanceas necessary. (The observation can be done within the same room, through a viewing window, or by reviewing videorecordings or audio recordings.)

• I agree to provide the student’s faculty instructor and practicum coordinator with a formative evaluation of the student’sprogress at the end of trimester one and a summative evaluation at the end of trimester two. I understand for eachevaluation, I will need to complete an evaluation form and participate in a conference call with the student’s faculty instructor, both of which will be in English.

• I agree to inform the student’s faculty instructor, practicum coordinator and the student immediately if any unforeseenissues arise that may affect this practicum experience or if, for any reason, it is necessary for me to withdraw from theagreed commitments.

• I understand the student is required to prepare three video recordings of live client sessions for faculty instruction. Thesesessions must be conducted in English. If site policy or affiliation agreement with Yorkville University does not allow forvideo or audio recordings of client sessions, I agree to assist the student with developing an appropriate scenario for a simulated client session. I will also assist the student in finding an appropriate person to play the role of the client for recording purposes.

• I agree to ensure the student will be provided with every opportunity to meet the practicum requirements listed below:- 400 total practicum hours;- 200 direct client contact hours;- Of the 200 direct client contact hours, 120 must be direct mental health counselling hours in the form of individual,family or couples therapy; the majority of which should be individual therapy;

• I understand the student must complete approximately 30 percent of the required direct client contact hours (60 hours)to receive a passing grade for Trimester One (PSYC7113) and to proceed to Trimester Two (PSYC7203)of the Practicumcourses.

• I understand at least 50 percent of the student’s sessions with clients must be conducted in English.

• I understand and agree that the student is not expected to market their own services and will instead be assignedappropriate clients for their level of experience and competence.


N

Practicum Terms of Agreement (for Supervisor) (Page 2 of 2)

• I agree to accept responsibility for the verification of the practicum student’s practicum hours. In doing so I acknowledgepracticum students in Yorkville University’s Master of Arts in Counselling Psychology program track their practicum hoursin a third-party online application called Time2Track. I further acknowledge that, upon being approved as a supervisor for a Yorkville University practicum student, essential supervisor and site information (including contact information and supervisor credentials) will be entered in Time2Track by the Yorkville University Field Training administration. This action will prompt an invitation to Time2Track by email and further information about how to use the service a week prior to the start of practicum. Upon receipt of the invitation I commit to complete the registration process outlined by Time2Track. Please Note: The Time2Track application keeps supervisor and site information confidential and is completely free for supervisors to use.

• I acknowledge that co-facilitation of client therapy is permitted and encouraged by the university, but at least 50 percent ofthe practicum student’s 120 total therapy hours must be conducted by the student independently.

• I agree that Yorkville University may release information regarding my credentials to regulatory bodies or professionalassociations should a student I supervise apply to be recognized by that organization.

Student safety:

Because student and client safety is paramount:

• Prior to the practicum student being assigned any clients I agree to discuss with the student and ensure that the student isfully informed of the practicum agency’s safety procedures, including any and all safety procedures and/or protocols at anyand all locations where the student will be engaging in practicum activities.

• I understand the student is not to be alone onsite at any time when providing services to clients, and there must be apracticum agency employee onsite who understands how to activate the safety plan if needed. This includes evening andweekend onsite hours, and any times which may involve the student being in satellite offices or on the premises of sister orcooperating agencies.

• I understand I must be fully aware of the student’s client schedule and be available either onsite or by phone at all timeswhen the student is providing services to clients. This applies to both onsite and external supervisors.

• I understand Yorkville University practicum students are not permitted to conduct client counselling sessions throughhome visits.

Consent to inform clients:

• I agree to confirm that Consent to Treatment forms and, where relevant, Consent and Release Form for Client Case Studyforms will be obtained from all clients of the Yorkville University practicum student, as required, and that these forms willbe kept in the confidential custody of the practicum site.

• I further confirm these consents will be freely given by the clients who will be fully informed of the meaning of theseconsents.

• Confirmation that these informed consents have been obtained will be provided by me at the time the student provides mewith the Confirmation of Hours Summary Sheet. This confirmation will be provided at the end of each trimester.

I agree to read the most current version of the Practicum Portal

Typed Name of Supervisor Date: Month/ Day/ Year

Signature of Supervisor

Typed Name of Second Supervisor (if applicable) Date: Month/ Day/ Year



N

Acknowledgement of Supervisor and Supervision Requirements

To be submitted with YU Practicum Placement Application. If you have been approved to have two practicum sites, please include a copy of this document with each Practicum Placement

Application. If you have two supervisors, both should sign one form.

In consideration of Yorkville University (hereon referred to as the University), permitting me to complete my training as a Practicum Student in their Master of Arts in Counselling Psychology program at

, I, Please type name of site Please type name of student

do hereby acknowledge and agree as follows: • I have been informed and accept that the University has set a minimum standard regarding the required credentials for

practicum supervisors and have been further advised that the University’s requirements may differ from those of someregulatory bodies or professional association .

• I have been advised by the University to make myself aware of the supervisor and supervision requirements for theregulatory body or professional association with which I wish to become a member after graduation.

• If I wish to register with an organization post-graduation, I have contacted

Please type name of regulatory body and or professional association(s)

directly to obtain the most up-to-date information. • I also understand that a proposed practicum supervisor will not be officially approved by the Dept. of Field Training if

his/ her/ their credentials do not meet the minimum standards set by the University.

Signature of Student Date: Month/ Day/ Year

Confirmation of supervisor: [Must be signed by the proposed practicum supervisor(s). If there are two proposed supervisors at this site, please have both supervisors complete this section]:

confirm I have reviewed this document and discussed its content with:

Signature of Supervisor Date: Month/ Day/ Year



Date: Month/ Day/ Year

I,

Please type name of supervisor Please type name of second supervisor if necessary

Please type name of student

Please check one of the following:

☐As such, I am fully aware of both the University’s requirements and the regulatory body and/or professionalassociation’s requirements for supervisor and supervision, and have done my due diligence to ensure that myproposed practicum supervisor(s) credentials are consistent with the requirements of

Please type name(s) of regulatory bodies and/or professional associations you plan to join after graduation

☐I do not plan to become a member of any regulatory body or professional associations after graduation and willfollow the University’s requirements.

Student SectionsRow1: Student SectionsRow2: For practicum in place of employment only: For practicum in place of employment only_2: For practicum in place of employment onlyRow1: For practicum in place of employment onlyRow2: For practicum in place of employment onlyRow3: For practicum in place of employment onlyRow4: For practicum in place of employment onlyRow5: For practicum outside of Canada only: Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisorRow1: Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisorRow2: Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisorRow3: Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisorRow4: Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisorRow5: Supervisor Sections Follow directives in IMPORTANT ADDITIONAL NOTES if more than one site or supervisorRow6: Additional Documents Only if Required by Site as Identified on Page 2 of Site Information Forms Follow directives in IMPORTANT ADDITIONAL NOTESRow1: Additional Documents Only if Required by Site as Identified on Page 2 of Site Information Forms Follow directives in IMPORTANT ADDITIONAL NOTESRow2: Additional Documents Only if Required by Site as Identified on Page 2 of Site Information Forms Follow directives in IMPORTANT ADDITIONAL NOTESRow3: Additional Documents Only if Required by Site as Identified on Page 2 of Site Information Forms Follow directives in IMPORTANT ADDITIONAL NOTESRow4: First Name: Last Name: Last Name_2: Student: Address: City: Province: Province_2: Country: Postal Code: Phone: When will your last MACP academic course be completed: No: If yes how many times have you had to defer: week of the trimester Please specify your practicum start and end dates: End date: PostSecondary Education Degrees Diplomas Certificates INCLUDE MAJOR OR SPECIALIZATION common abbreviations acceptableRow1: Educational Institution or OrganizationRow1: Start Date M D YRow1: End Date M D YRow1: PostSecondary Education Degrees Diplomas Certificates INCLUDE MAJOR OR SPECIALIZATION common abbreviations acceptableRow2: Educational Institution or OrganizationRow2: Start Date M D YRow2: End Date M D YRow2: PostSecondary Education Degrees Diplomas Certificates INCLUDE MAJOR OR SPECIALIZATION common abbreviations acceptableRow3: Educational Institution or OrganizationRow3: Start Date M D YRow3: End Date M D YRow3: PostSecondary Education Degrees Diplomas Certificates INCLUDE MAJOR OR SPECIALIZATION common abbreviations acceptableRow4: Educational Institution or OrganizationRow4: Start Date M D YRow4: End Date M D YRow4: PostSecondary Education Degrees Diplomas Certificates INCLUDE MAJOR OR SPECIALIZATION common abbreviations acceptableRow5: Educational Institution or OrganizationRow5: Start Date M D YRow5: End Date M D YRow5: PostSecondary Education Degrees Diplomas Certificates INCLUDE MAJOR OR SPECIALIZATION common abbreviations acceptableRow6: Educational Institution or OrganizationRow6: Start Date M D YRow6: End Date M D YRow6: Workshops TrainingRow1: Educational Institution or OrganizationRow1_2: Start Date M D YRow1_2: End Date M D YRow1_2: Workshops TrainingRow2: Educational Institution or OrganizationRow2_2: Start Date M D YRow2_2: End Date M D YRow2_2: Workshops TrainingRow3: Educational Institution or OrganizationRow3_2: Start Date M D YRow3_2: End Date M D YRow3_2: Workshops TrainingRow4: Educational Institution or OrganizationRow4_2: Start Date M D YRow4_2: End Date M D YRow4_2: Workshops TrainingRow5: Educational Institution or OrganizationRow5_2: Start Date M D YRow5_2: End Date M D YRow5_2: Workshops TrainingRow6: Educational Institution or OrganizationRow6_2: Start Date M D YRow6_2: End Date M D YRow6_2: Workshops TrainingRow7: Educational Institution or OrganizationRow7: Start Date M D YRow7: End Date M D YRow7: Name of Place of EmploymentRow1: Position TitleRow1: Avg Hours Worked WeekRow1: DutiesRow1: Name of Place of EmploymentRow2: Position TitleRow2: Avg Hours Worked WeekRow2: DutiesRow2: Name of Place of EmploymentRow3: Position TitleRow3: Avg Hours Worked WeekRow3: DutiesRow3: Name of Place of EmploymentRow4: Position TitleRow4: Avg Hours Worked WeekRow4: DutiesRow4: Name of Place of EmploymentRow5: Position TitleRow5: Avg Hours Worked WeekRow5: DutiesRow5: Name of Place Where VolunteeredRow1: Position TitleRow1_2: Avg Hours Volunte ered WeekRow1: Start Date M D YRow1_3: End Date M D YRow1_3: DutiesRow1_2: Name of Place Where VolunteeredRow2: Position TitleRow2_2: Avg Hours Volunte ered WeekRow2: Start Date M D YRow2_3: End Date M D YRow2_3: DutiesRow2_2: Name of Place Where VolunteeredRow3: Position TitleRow3_2: Avg Hours Volunte ered WeekRow3: Start Date M D YRow3_3: End Date M D YRow3_3: DutiesRow3_2: Position TitleRow4_2: Avg Hours Volunte ered WeekRow4: Start Date M D YRow4_3: End Date M D YRow4_3: DutiesRow4_2: Position TitleRow5_2: Avg Hours Volunte ered WeekRow5: Start Date M D YRow5_3: End Date M D YRow5_3: DutiesRow5_2: Monday700am 800am: Tuesday700am 800am: Wednesday700am 800am: Thursday700am 800am: Friday700am 800am: Saturday700am 800am: Sunday700am 800am: Monday800am 900am: Tuesday800am 900am: Wednesday800am 900am: Thursday800am 900am: Friday800am 900am: Saturday800am 900am: Sunday800am 900am: Monday900am 1000am: Tuesday900am 1000am: Wednesday900am 1000am: Thursday900am 1000am: Friday900am 1000am: Saturday900am 1000am: Sunday900am 1000am: Monday1000am 1100am: Tuesday1000am 1100am: Wednesday1000am 1100am: Thursday1000am 1100am: Friday1000am 1100am: Saturday1000am 1100am: Sunday1000am 1100am: Monday1100am 1200pm: Tuesday1100am 1200pm: Wednesday1100am 1200pm: Thursday1100am 1200pm: Friday1100am 1200pm: Saturday1100am 1200pm: Sunday1100am 1200pm: Monday1200pm 100pm: Tuesday1200pm 100pm: Wednesday1200pm 100pm: Thursday1200pm 100pm: Friday1200pm 100pm: Saturday1200pm 100pm: Sunday1200pm 100pm: Monday100pm 200pm: Tuesday100pm 200pm: Wednesday100pm 200pm: Thursday100pm 200pm: Friday100pm 200pm: Saturday100pm 200pm: Sunday100pm 200pm: Monday200pm 300pm: Tuesday200pm 300pm: Wednesday200pm 300pm: Thursday200pm 300pm: Friday200pm 300pm: Saturday200pm 300pm: Sunday200pm 300pm: Monday300pm 400pm: Tuesday300pm 400pm: Wednesday300pm 400pm: Thursday300pm 400pm: Friday300pm 400pm: Saturday300pm 400pm: Sunday300pm 400pm: Monday400pm 500pm: Tuesday400pm 500pm: Wednesday400pm 500pm: Thursday400pm 500pm: Friday400pm 500pm: Saturday400pm 500pm: Sunday400pm 500pm: Monday500pm 600pm: Tuesday500pm 600pm: Wednesday500pm 600pm: Thursday500pm 600pm: Friday500pm 600pm: Saturday500pm 600pm: Sunday500pm 600pm: Monday600pm 700pm: Tuesday600pm 700pm: Wednesday600pm 700pm: Thursday600pm 700pm: Friday600pm 700pm: Saturday600pm 700pm: Sunday600pm 700pm: Monday700pm 800pm: Tuesday700pm 800pm: Wednesday700pm 800pm: Thursday700pm 800pm: Friday700pm 800pm: Saturday700pm 800pm: Monday800pm 900pm: Tuesday800pm 900pm: Wednesday800pm 900pm: Thursday800pm 900pm: Friday800pm 900pm: Saturday800pm 900pm: Total onsite practicum hours: TOTAL WEEKRow1: TOTAL WEEKRow2: TOTAL WEEKRow3: Date Month Day Year: Date Month Day Year_2: Date Month Day Year_3: signed this pledge of confidentiality: Typed Name of Witness: Date Month Day Year_4: Name of Proposed Site: Phone Number: Address_2: City_2: Province_3: Country_2: Website: Postal Code_2: Name of Parent Organization if applicable eg Alberta Health Services Ministry of Child and Family Development School Board or District etc: Yes: No_2: Name: PositionTitle: Phone_2: Email: Child Guidance Clinic: Private Practice: Schools: Community Mental Health: DepartmentSchool Clinic: University CounselStudent Mental Health: Medical ClinicHospital: ForensicJustice Jail: Inpatient Psychiatric Hospital: Outpatient Psychiatric ClinicHospital: Partial HospitalizationIntensive Outpatient Program: ResidentialGroup Home: VA Medical Center: Other: Please Specify: Family: Women: Youth: LGBTQ: Military: Children: Men: Other_2: Please Specify_2: Addictions Services: CouplesMarriage Therapy: Group Therapy: Anger Management: Eating Disorders Therapy: Individual Therapy: Assessments: Family Therapy: Psychiatric Mental Health Counselling: BereavementGrief Counselling: General Mental Health Counselling: Trauma Counselling: Please Specify_3: Other_3: Please Specify_4: Please indicate what theory or theories of practice the student will be expected to practice with your clients at this site For example Cognitive Behavioural Therapy Narrative Therapy Solution Focused Therapy Rogerian Therapy Adlerian Therapy etcRow1: Yes_2: No_3: Yes_3: No_4: Yes_4: No_5: Yes_5: No_6: Yes_6: No_7: Yes_7: No_8: Yes_8: No_9: Typed Name of Supervisor: Date Month Day Year_7: Typed Name of Second Supervisor if applicable: Date MonthDayYear: Dr: Mr: Ms: First Name_2: Last Name_3: Work Address: City_3: Province_4: Country_3: Email_2: Work Phone: Postal Code_3: Position Title: Counsellor: Social Worker: Psychologist: Other_4: Name of Professional Association: Code of Ethics: Years of clinical counselling experience: Highest degree in clinical counsellingpsychologysocial work and year obtained: Yes_9: No_10: Years of experience in providing clinical supervision: Applicable training in supervision note course names etc as applicable: Other notable information: Primary Supervisor: Co supervisor: Onsite: External: Name_2: Position Title: Email_3: Phone_3: Yes_10: No_11: Typed Name of Supervisor_2: Date Month Day Year_8: Typed Name of Second Supervisor if applicable_2: Date Month Day Year_9: Please type name of site: Please type name of student: Please type name of regulatory body and or professional associations: Please type names of regulatory bodies andor professional associations you plan to join after graduation: Date Month Day Year_10: Please type name of supervisor: Please type name of second supervisor if: Please type name of student_2: Date Month Day Year_11: Date Month Day Year_12: Additional Documents please note: M D Y: M D Y5: M D Y6: M D Y7: M D Y8: M D Y9: M D Y10: M D Y2: M D Y3: M D Y4: Name of Place Where VolunteeredRow4: Name of Place Where VolunteeredRow66: Sunday700pm 800pm: Sunday800pm 900pm: Total employment hours: Total practicum course work hours: 0: 0: 1: 2: 3: 4: 5: 6:

1: 1: 2: 3: 4: 5: 6:

Total employment hours1: Total employment hours2: Total employment hours3: Total employment hours4: Total employment hours5: Total employment hours6: P of C Student name: Check Box3: OffCheck Box4: OffTyped name of student: I am aware that of the 400 total practicum hours 200 of them must be direct client contact hours: I am aware that of the 200 direct client contact hours 120 of them must be direct mental health counselling: I am aware that at this stage of my training the majority of the 120 direct counselling hours should involve individual therapy: I am aware that students are no longer required to complete group therapy hours If my site and I decide that group therapy will be incorporated into my practicum I am aware that psychosocial psychoeducation services career vocational academic counselling and support group services do not fulfill the requirements for group therapy It must be group mental health counselling: I am aware that in addition to all course assignments in Trimester One I must complete approximately 30 percent of the required direct client contact hours 60 hours to receive a passing grade for Trimester One and to proceed to Trimester Two of the PSYC7106 Practicum course: I am aware that in in order for me to obtain my required direct client contact hours by the end of my practicum I should average six or seven hours of direct client contact hours per week: I am aware that in order for me to obtain my required direct counselling hours by the end of my practicum I should average four hours of direct counselling per week: I am aware that indirect client contact such as reviewing case files session preparation case notes and maintaining case files formal report writing case consults and research and reading can take as much time per week as direct client contact hours: I am aware that I must have a minimum of one hour of face to face supervision with my site supervisor per 135hour week: I am aware that some sites may require me to find my own clients and that these sites will not be approved as a viable practicum: I am aware that some sites may require me to engage in valuable activities eg attending staff meetings symposiums training workshops etc that may take time away from the 135 hours per week I will need to obtain my direct client contact hours which may require me to devote more than 135 hours per week toward practicum: I am aware that I am required to have a minimum of 400 total practicum hours: For RP CRPO supervisors only: THMC Request Form: