tentative school practicum/internship guide subject to change...supervisor, site supervisor, and...

04/2017 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

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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

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

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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.

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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.

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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.

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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.

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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)

https://www.educateiowa.gov/

http://www.boee.iowa.gov/

http://www.boee.iowa.gov/seeking_other.html

04/2017 8

School Counseling Practicum


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

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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

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School Counseling Practicum or Internship


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)

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Direct Hours at 5-12:






Total Direct Hours at 5-12 __________

Indirect Hours at 5-12:





Other __________



On-site __________




Total Indirect Hours at 5-12 __________


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GRAND TOTAL HOURS __________

Student signature: _______________________________ Date: ________________

Site Supervisor Signature (K-8): ____________________________ Date: ______________

Site Supervisor Signature (5-12): ____________________________ Date: ______________

University Supervisor Signature: ____________________________ Date: ______________

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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.

04/2017 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

04/2017 15

c. Stimulation and professional growth from the experience of

supervising/mentoring.

04/2017 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.

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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.

04/2017 18

12. Meet with the site and university supervisors each semester for a mid-term and final

evaluation of the internship.

04/2017 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.

04/2017 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.

04/2017 21

School Counseling Internship


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

04/2017 22

School Counseling Internship


Internship Final Hours Log

Name____________________________Semester/year_____________Week_____________

Site Supervisor_____________________ Site_______________________

Direct Hours:






Total Direct Hours __________

Indirect Hours:





Other __________



On-site __________




Total Indirect Hours __________


04/2017 23

GRAND TOTAL HOURS __________

Student signature: _______________________________ Date: ________________

Site Supervisor Signature: ____________________________ Date: ______________

University Supervisor Signature: ____________________________ Date: ______________

04/2017 24


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.

04/2017 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


12. Adequate research resources and/or assessments were available


13. Library services were accessible


14. Overall, university services and support systems facilitated my graduate education


15. I was satisfied with the teaching abilities of the full-time faculty


16. I was satisfied with the teaching abilities of the part-time faculty


17. All factors considered, I was satisfied with my graduate program


18. My professors are available for help/questions outside of class.


19. My courses are relevant to my chosen program of study.


20. My professors have provided a clear understanding of the goals and requirements

of each class.


21. Academic/professional interaction with others has contributed significantly to my

attaining my educational goals.


22. Compared to when I entered the graduate program, I have a stronger ability to think

critically.


23. I have enhanced my problem-solving skills as a direct result of being in this

program.


24. Graduating from a CACREP accredited program has been beneficial to me

professionally


REGARDING MY ACADEMIC ADVISOR

25. My advisor was a good listener and provided individual attention.


04/2017 26

26. My advisor provided ample time to discuss problems and concerns.


27. My advisor provided adequate information.


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:


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


2. The experience requirements were valuable in preparation for job functioning


3. My supervisor for this experience was aware of my professional strengths and

weaknesses and helped me to improve my professional skills.


Questions 4-10 General questions:

4. I would recommend this program to a friend.


04/2017 27

5. This program prepared me to be a multiculturally competent counselor.


6. The difficulty level of this program is what I expected for graduate level studies.


7. I expect to derive long-term benefit from this program.


8. I had adequate leadership opportunities.


9. I was mentored professionally and there were adequate opportunities to

professionally grow.


10. I was successful at finding a job within one year.


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:_______________________________________________________________

______________________________________________________________________________

____________________________________________________________________________

04/2017 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.

04/2017 29



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.)

04/2017 30



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.)

04/2017 31



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

04/2017 32

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

04/2017 33

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

04/2017 34

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: _________________________________________________

04/2017 35



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

04/2017 36

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: ____________

04/2017 37



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:

1. Gives time in reviewing my tapes and discussing cases 0 1 2 3 4

2. The faculty 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. Encourages and listens to my ideas and suggestions for developing my

counseling skills

0 1 2 3 4

7. Provides suggestions for developing my counseling skills 0 1 2 3 4

8. Helps me to understand the implications and dynamics of the

counseling approaches I utilize

0 1 2 3 4

9. Encourages me to use new and different techniques when appropriate 0 1 2 3 4

10. The faculty supervisor demonstrated multicultural competencies 0 1 2 3 4

11. Helps me to define and achieve specific concrete goals for myself

during the practicum/internship experience

0 1 2 3 4

12. Gives me useful feedback when I do something inappropriate 0 1 2 3 4

04/2017 38

13. Allows me to discuss problems I encounter in my practicum/internship

setting

0 1 2 3 4

14. Focuses on both verbal and nonverbal behavior in me and in my

clients

0 1 2 3 4

15. Helps me define and maintain ethical behavior in counseling and case

management

0 1 2 3 4

16. Encourages me to engage in professional behavior 0 1 2 3 4

17. Maintains confidentiality in material discussed in supervisory sessions 0 1 2 3 4

18. Deals with both content and affect when supervising 0 1 2 3 4

19. Focuses on the implications, consequences, and contingencies of

specific behaviors in counseling and supervision

0 1 2 3 4

20. Helps me organize relevant case data in planning goals and strategies

with my client

0 1 2 3 4

21. Helps me to articulate my theoretical orientation 0 1 2 3 4

22. Offers resource information when I request or need it 0 1 2 3 4

23. 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

24. Allows and encourages me to evaluate myself 0 1 2 3 4

25. Explains his/her criteria for evaluation clearly 0 1 2 3 4

26. Applies his/her criteria fairly in evaluating my counseling

performance

0 1 2 3 4

27. The faculty supervisor was a good liaison to the counseling profession 0 1 2 3 4

28. The faculty supervisor informed me about professional growth

opportunities that would enhance my learning

0 1 2 3 4

29. Did your faculty placement meet your expectations 0 1 2 3 4

Additional Comments and/or Suggestions:

Student’s Signature: ___________________________________________ Date: ____________

04/2017 39



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

04/2017 40

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:

04/2017 41

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:

04/2017 42

1……………...2………………3……………….4………………5 N/A

12. The following suggestions should be considered for program improvement:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

tentative school practicum/internship guide subject to change...supervisor, site supervisor, and...

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