Counseling Program
University of North Texas
Information for Completion of the COUN 5720 & 5721
INTERNSHIP APPLICATION
1. During the final weeks of COUN 5690 Practicum, the student needs to complete the
INTERNSHIP APPLICATION form that is part of this Internship packet. The entire
packet – either Agency or School --- can be downloaded and printed from the Counseling
home page at www.coe.unt.edu/che/coun then link to Resources. The application form
indicates your first and second choices for an internship site. For information about
acceptable internship sites that the Counseling Program has pre-approved you may
download and print out the 10 page list from the Counseling home page at
www.coe.unt.edu/che/coun and link to Resources. If you choose a site that is not on the
approved list, please visit with the faculty internship coordinator to clarify the
requirements for an appropriate internship site.
Complete the Internship Application and ask your Practicum instructor to sign it. The
faculty signature indicates that you are ready to proceed with Internship. Then, submit
the application to the Counseling Office in Stovall 155 before the end of the semester.
2. Students who are employed full time in educational institutions may complete half of the
600 clock hours of school counseling internship at the school where they are employed and
must complete the other 300 hours during the preceding or succeeding summer. Students
should arrange for supervision at the school where they are employed with the resident
school counselor or other appropriate veteran school counselor. Summer internships for
these students must be arranged with the appropriate internship faculty member during the
spring preceding summer enrollment for Internship II.
3. Students who are not employed and who are applying for full time school counseling
internships should schedule an appointment with the appropriate internship faculty
member before submitting the Internship Application.
4. Both COUN 5720 Internship I and COUN 5721 Internship II will meet together for an
Orientation one night during the first week of the semester. Date, time, place will be
announced closer to the beginning of the semester via Eagle Connect. At that time all the
other forms in the Internship Packet will be discussed. Bring your packet with you to
that first meeting. A university representative will come and visit with you and your
supervisor at various times throughout your internship placement. At the first meeting
you will need to provide important contact information such as names, phone
numbers, addresses and directions to your Internship Site.
5. Future class dates/times will be determined at the first meeting.
Internship Placement – Internship I & II are very important to the completion of this part of your
education. We want you to have the very best experience possible! BEST WISHES!
1
Counseling Program
University of North Texas
COUN 5720 & 5721
INTERNSHIP APPLICATION
Student’s Name: Date:
Mailing Address:
City: State: Zip:
Home Phone: Work Phone:
Internship Experience to Begin on and End on
Degree Track (circle one) Elementary School Secondary School Community Child
Community Adult College/University
Please list Internship Experience preferences. Be as specific as possible.
1. Desired location of Internship Placement:
Type of Agency or School:
Type of Experience:
2. Desired location of Internship Placement:
Type of Agency or School:
Type of Experience:
I, have been given permission to register for
(Student Name)
COUN 5720 Internship I, as indicated by the supervisor’s signature below.
Practicum Supervisor
(Signature)
Practicum Supervisor Date
(Type or Print)
This form is Page 1 of a 2 page form that is to be submitted to
the Counseling Office in Stovall 155
before the end of the semester that you complete COUN 5690 Practicum
2
Counseling Program
University of North Texas
STUDENT DATA SHEET
COUN 5720 Internship I and COUN 5721 Internship II
Name: Today’s Date:
Address: Phone:
City: State: Zip:
Highest Degree Held: Year Granted:
Institution:
Planned date
Degree presently working toward: of graduation:
Related employment history (present position first):
Name of Institution or Agency Dates Title
Remaining courses in counseling program:
Course number and Title
(GPA to present time: )
This form is Page 2 of a 2 page form that is to be submitted
along with the Internship Application form
to the Counseling Office in Stovall 155
before the end of the semester that you complete COUN 5690 Practicum
3
INTERNSHIP MEETINGS
Throughout the semester, Internship students are required to attend scheduled class
meetings. In order for Dr. Fernando to assign you to meet with a particular group, please
mark your 1st and 2nd choice of which night/s you will be available to meet. These meeting are
typically held 4 or 5 times during the semester but will be consistently set on a particular
week night. Exact dates will be discussed at the required orientation which is always held
one evening during the first week of classes. Room #, date, and time will be provided in a
follow-up bulk mail, so be watching your Eagle Connect.
Name__________________________________________
Student ID _____________________________________
Phone Number__________________________________
Email___________________________________________
Please mark 1st and 2nd choices:
Monday __________
Tuesday__________
Wednesday__________
Thursday___________
This form must be returned to the Counseling
office no later than one week before the start of
the semester.
You can print this form and:
Scan and email to kayla.west@unt.edu
or
Fax to 940-565-2905
or
Mail to the office at UNT Counseling Program
1155 Union Circle #310829
Denton, TX 76203-5017
or
Bring to Stovall Hall 155
4
COUN 5720/5721
School Internship
UNT Counseling Program
Internship Coordinator
1155 Union Circle #310829
Denton, TX 76203-5017
940:565-2910
Fax 940:565-2905
1. 3X5 Card --- to be filled out at Internship Orientation/1st Meeting
Name: Last, first Name of site
Address Address
City, State, Zip City, State, Zip
Phone # home Phone #
Phone # work Name of supervisor
CP
E-mail
1. BACK OF CARD: EXACT directions to place of employment from UNT and mileage one way.
2. Proof of insurance.
3. Graduation paperwork
4. Five group supervision meetings
5. Two on-site group supervision, student and faculty member
6. Complete all paperwork as designated; secure faculty member’s signature
7. Organize all paperwork according to checklist
8. Copy of all paperwork for student/originals for faculty member
9. Exit interview (must be scheduled before graduation) with faculty member
10. Name on top right of ALL papers
11. Review evaluations with supervisor/with student before mailing
5
GRADUATION
REMINDER!
Apply for Graduation - you may apply up to one year before you graduate, and you must apply no
later than the deadline set by the graduate school. For graduation information, call the UNT
Graduate School, located in the Eagle Student Services Center, 940-565-2383.
Credentialing Information
School Counselor Certification: Next 3 pages in School Internship Packet (Not in Agency packet)
Temporary License: You may request a temporary license packet from the Texas Board of Examiners of
Professional Counselors, P.O. Box 149347, Austin, TX 78714-9347, (512)834-6658 or through their website at
www.dshs.state.tx.us/counselor/default.shtm . The NCE is now the Texas licensing exam. You must take it and
pass it before becoming an LPC Intern.
Examination: UNT Counseling Program graduates are eligible for the National Certified Counselor (NCC)
credential once they graduate and pass the National Counselor Examination (NCE). Students can apply for the
NCE by following the directions posted on the NBCC website, www.nbcc.org. NCE preparation/study materials
are available on a reserve bases through the UNT Counseling Program Center for Counseling and Human
Development and the Willis Library.
Doctoral Studies: UNT’s counselor education doctoral program might be a logical and poignant next step for
you. Information and application packets are available in our office in Stovall Hall Rm. 155 or from the
Counseling Program home page at www.coe.unt.edu/che/coun
6
Public School Counselor Certification in Texas
1. For certification, you must have at least two years of teaching experience in an accredited school. If you
have not done so already, you need to submit the following to the Student Advising Office in Matthews
Hall, Room 105:
a. A copy of your degree plan
b. A teacher service record – two years teaching experience
2. You must successfully complete the TExES School Counselor exam as one condition for school counselor
certification. Please contact the TExES Advising office in Matthew Hall, Room 103, phone:
940-369-8601, for assistance. The test is administered year-round. You may register to sit for the exam at
the start of internship and after the successful completion of:
COUN 5710 Counseling Theories
COUN 5600 Counseling in the Secondary School
COUN 5770 Counseling in the Elementary School
COUN 5740 Group Counseling
COUN 5470 Career Development
COUN 5760 Appraisal in Child & Adolescent Counseling
COUN 5690 Practicum in Counseling
DFST 5123 Lifespan Human Development
a. Before you register to take the exam, you should make sure that you have completed ALL the
above listed courses. For your convenience, a Course Check List is part of this packet.
b. For registration dates, deadlines, testing information, and study tips, refer to the registration
bulletin available at the ETS website: Go to www.texes.ets.org, the TExES Office in Matthews
Hall, 103 -940-369-8601, or your local ISD administration building.
3. Apply for teacher certification at: www.sbec.state.tx.us
● A fee is required. Online fee payment is available.
● The system will prompt if you need to submit your fingerprint scan/card.
UNT will recommend you for certification when you have passed your certification exams and your degree is
posted on your transcript. This can take 4-6 weeks.
For specific inquiries, contact Stella Winsett, Certification Specialist, in the Student Advising Office,
Matthews Hall 105, phone: 940-565-2740, or the State Board for Educator Certification, 1701 North Congress
Ave, WBT 5-100 Austin, TX 78701-1494, (512) 936-8400.
Instructions also available at: www.coe.unt.edu/sao/TeacherCertification/CertAppInstruc.html
7
Counseling Program
University of North Texas
Course Checklist for TExES Exam
All of these courses must be COMPLETED
before you take the TExAS Exam for School Counselors
Course Completed
COUN 5710 Counseling Theories
COUN 5600 Counseling in the Secondary School
COUN 5770 Counseling in the Elementary School
COUN 5740 Group Counseling
COUN 5470 Career Development
COUN 5760 Appraisal in Child & Adolescent Counseling
COUN 5690 Practicum in Counseling
DFST 5123 Lifespan Human Development
8
Counseling Program
University of North Texas
INTERNSHIP HOURS THAT APPLY TOWARD LPC HOURS
Required for Internship at UNT – 700 hours
Practicum I 100
Internship I & II 600
Total hours earned at UNT 700
Client contact hours
Practicum 40
Internship 240
Total Client Contact 280
The State of Texas requires 300 total hours with 100 client contact hours in a
masters program to be eligible for an LPC.
UNT students have 400 hours extra with 180 client contact hours that will be applied towards
their LPC. The LPC Board will not accept more than 400 hours from a masters program to carry
forward.
Delini Fernando, Ph.D.
Assistant Professor
University of North Texas
9
PREPARATION GUIDE
FOR THE
NATIONAL COUNSELOR EXAMINATION FOR
LICENSURE AND CERTIFICATION
(NCE)
The Official Guide for the NCE
Describes the NCE
Answers commonly asked questions about the NCE
Suggests test-taking strategies
Helps you assess your strengths and weaknesses regarding the subject matter covered by the exam
Assists you in setting study priorities
Lists over 40 potential resources for study and review
Provides 134 practice examination questions
Includes 38 former examination questions with justified responses
Developed and distributed by the National Board for Certified Counselors (NBCC), this guide will help you understand and
prepare for the National Counselor Examination for Licensure and Certification (NCE). In an effort to reduce anxiety
regarding the examination, we have tried to anticipate your questions about the nature of the examination and the testing
procedures.
Price: $24.95 (Price includes postage and handling)
To order your preparation guide for the NCE, please go to:
http://www.nbcc.org/extras/pdfs/nbcc_orderform.pdf
10
NATIONAL BOARD FOR CERTIFIED COUNSELORS
3 Terrace Way
Greensboro, NC 27403
(336) 547-0607
(919) 547-0017 FAX
The National Board for Certified Counselors was begun as a result of the American Association for Counseling and
Development’s professional endeavors in the area of credentialing. NBCC is an independent, non-profit organization whose
primary purposes are: (a) establishing and monitoring a national certification system; (b) identifying to professionals and
members of the public those counselors who have voluntarily sought and obtained certification; and (c) maintaining a
register of those counselors. The certification process grants recognition to counselors who have met NBCC standards in
their education, experience, and performance on the National Counselor Examination.
Information packets on eligibility and on administrations of the National Counselor Examination are available at
www.nbcc.org or from the address listed above. Study guides are also available.
The National Counselor Examination covers the following content areas:
1. Human Growth and Development
2. Social and Cultural Foundations
3. Helping Relationships
4. Group Work
5. Life-style and Career Development
6. Appraisal
7. Research and Program Evaluation
8. Professional Orientation & Ethics
Helpful Internet Addresses
Licensed Professional Counselor
WWW address: http://www.dshs.state.tx.us/counselor/default.shtm
Marriage and Family Therapist
WWW address: http://www.dshs.state.tx.us/mft/mft_aonline.shtm
Licensed Social Worker
WWW address: http://www.dshs.state.tx.us/socialwork/default.shtm
Sex Offender Treatment Providers
WWW address: http://www.dshs.state.tx.us/csot/default.shtm
Licensed Chemical Dependency Counselor
WWW address: http://www.dshs.state.tx.us/lcdc
11
TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
Mail Code 1982, P.O. Box 149347, Austin, Texas 78714-9347 (512) 834-6658)
http://www.dshs.state.tx.us/counselor/lpc_apply.shtm
Normal human growth and development – any course which deals with the process and stages of human
intellectual, physical, social and emotional development from prenatal origins through old age
Abnormal human behavior – any course which offers study in the principles of understanding dysfunction in
human behavior or social disorganization.
Appraisal or assessment techniques – any course which deals with the principles, concepts, and procedures of
systematic appraisal of client needs which may include the use of both non-testing approaches and test
instruments but not projective techniques.
Counseling theories – any course which surveys the major theories of counseling.
Counseling methods or techniques – at least two courses in methods or techniques used to provide counseling
services including one course in counseling individuals.
Group dynamics, theories, techniques – any course dealing with the theory and types of groups including
dynamics and the methods of practice with groups.
Research – any course in the methods of research which may include the study of statistics or a thesis project in an
area relevant to the practice of counseling.
Life style and career development – any course which deals primarily with areas such as theories of vocational
choice, career choice and life style, sources of occupational and educational information and career
decision-making processes.
Social and cultural foundations – any course which deals primarily in areas such as studies of change, ethnic
groups, roles of women, urban and rural societies, population patterns, cultural patterns and differing life styles.
Professional orientation – any course which deals primarily with the objectives of professional organizations,
codes of ethics, legal aspects of practice, standards of preparation and the role identity of persons providing direct
counseling services.
12
Counseling Program
University of North Texas
INTERNSHIP RECORD FORM T.F.
STUDENT NAME STUDENT ID (AREA CODE) HOME PHONE
SITE ASSIGNMENT SITE SUPERVISOR (AREA CODE) WORK PHONE
1. RECEIVED THE FOLLOWING REQUIRED DOCUMENTS:
A) INTERNSHIP APPLICATION FORM E) INSURANCE VERIFICATION
B) SUPERVISION AGREEMENT F) ETHICAL GUIDELINES
C) INTERNSHIP CONTRACT G) RELEASE OF INFORMATION
D) INTERNSHIP GUIDELINE
2. AGENCY PROFILE & PRESENTATION COMPLETED? DATE
3. CASE CONCEPTUALIZATION COMPLETED? DATE #1 DATE #2
4. MIDTERM EVALUATION COMPLETED? DATE RECEIVED
5. FINAL EVALUATION COMPLETED? DATE RECEIVED
6. DATE & TIME OF FIRST SITE VISIT:
COMMENTS;
7. DATE & TIME OF SECOND SITE VISIT:
COMMENTS:
8. DATE & TIME OF THIRD SITE VISIT:
COMMENTS:
9. DATE & TIME OF FOURTH SITE VISIT:
COMMENTS:
13
DATE:
TO:
FROM: Dee Ray, Ph.D., Coordinator, Counseling Program
RE: School internship for
The above named student has indicated an interest in obtaining a counseling internship placement in your school.
With your approval, the student will be placed in your school for hours per week for weeks
as part of the counselor preparation program. It is our expectation that the on-site internship experience will be
more than the supervised opportunity to provide guidance and counseling opportunities for students and will
include the student counselor’s participation in all usual activities of the school. Exposure to the work of a variety
of professionals within the school will broaden the student’s educational experience and provide better
preparation for the profession.
It is our belief that consistent supervision is vital to the student’s learning, and it is a requirement of the Texas
Licensed Professional Counselor law that students receive supervised experiences both on-campus and in the
field. To meet the State standards and our own, we require a minimum of one hour of individual supervision with
a qualified supervisor and two hours of group supervision (may be case conference or staff meeting) each week.
Finally, in evaluating the student’s performance, it is important for the supervisor to take into account the total
performance of the student. The ability to counsel, provide guidance activities, keep records, and maintain a
general professional attitude are all part of the criteria.
, Practicum Coordinator for the on-site internship will visit your school periodically
and will want to meet with you during the semester so that we will be in a better position to provide support if it is
needed. You should feel free to call the Coordinator at any time.
If you are in agreement with the above requirements and can comply with them, complete the attached
supervision agreement in consultation with the student. The student will return the original signed copy to the
Practicum Coordinator, and the second copy is for your file.
Thank you for contributing to the educational goals of our student. It is our intention that the student not be the
only one to benefit from this experience. Once a good working relationship is established, we hope our student
counselor will make a contribution to your school.
14
Counseling Program
University of North Texas
COUN 5720 and COUN 5721
Internship I & II
(For School Counselor Candidates)
These courses are designed to provide in-the-field supervised counseling experience for students who are in their
final semester of the Counseling Program. Emphasis is placed upon the performance of individual counseling,
group counseling, classroom guidance, and parent and teacher consultation. The ultimate goal for this course is to
prepare the student for employment as a school counselor.
Objective
Students will be expected to demonstrate the following competencies:
1. To plan and implement counseling (individual and group) in a school or equivalent setting.
2. To plan and implement classroom developmental counseling activities in a school or equivalent
setting.
3. To plan and implement consultation activities with administrators, parents, and teachers in a
school or equivalent setting.
4. To plan and implement a design for a comprehensive developmental counseling program in a
school or equivalent setting.
5. To participate in individual and group supervision activities.
6. To gain confidence as a school counselor and to identify oneself as a professional in the counseling
field.
The University of North Texas College of Education does not discriminate on the basis of disability in the recruitment and
admission of students, the recruitment and employment of faculty and staff, and the operation of any of its programs and
activities, as specified by federal laws and regulations. The designated liaison for the Counseling Program is Dr. Jan
Holden, Room 155, Stovall Hall. Copies of the College of Education ADA Compliance Document are available in the
Dean's Office, Matthews Hall 214.
The student has the responsibility of informing the course instructor of any disabling condition which will require
modifications to avoid discrimination.
School Objectives/Requirements/etc.
Page 2 of 3
Requirements
15
1. Class participation at all scheduled meetings.
2. Log - keep a comprehensive daily record of all counseling-related activities.
Personalize - include high points, frustrations, and overall reactions while
emphasizing lessons learned and implications. Include approximate amount of
time spent on each activity.
a. Internship activities (counseling/consulting/coordinating interventions)
b. Planning and preparation
c. Classroom activities
d. Supervision activities & individual and group
3. Processing Highlights: Weekly, email, mail or turn in a one or two-page processing
paper to your UNT supervisor, briefly noting activities, and emphasizing lessons
learned and implications of those lessons for future counseling. In all cases protect
privacy by avoiding use of actual names of schools, students, teachers and others.
4. Audio tape (turned in at each class meeting).
5. Prepare a paper comparing and contrasting the latest versions of the Texas
Education Agency’s A Model Developmental Guidance Program for Texas Public
Schools: A guide for Program Development Pre-K - 12th Grade Third Edition and
Career Development Implementation Handbook and the developmental guidance
program for your district. The primary goal of this project is to help students
articulate a clear, succinct personal explanation and description of school
counseling, school guidance and developmental school guidance programs.
Each student must complete a minimum of 600 hours of supervised practicum activities, including
240 direct client contact hours.
16
School Objectives/Requirements/etc.
Page 3 of 3
Activities
1. Individual counseling
2. Group counseling
3. Classroom developmental counseling activities
4. Consultation (administrators, parents, and teachers)
5. Assessment
6. Consultations with one-site and faculty supervisor
Internship Outline
I. Legal and Ethical Issues
II. Professional Identity and Organizations
III. Establishing a Comprehensive Developmental Counseling Program
IV. Individual Counseling (Coupled With Student’s Theoretical Approach)
V. Group Counseling
VI. Classroom Developmental Counseling
VII. School Assessment Programs and Individual Appraisal
VIII. Consultation With Parents
IX. Consultation With Teachers and Administrators
17
Counseling Program
University of North Texas
INTERNSHIP REQUIREMENTS
(School Counselor Candidate)
Placement in an appropriate school or equivalent setting.
Seminar Attendance:
Participation in the following seminar sessions is required:
______________________ _______________________
______________________ _______________________
______________________ _______________________
______________________ _______________________
Date Time Date Time
Written Assignments:
1. Each student will be required to keep a log of the activities that are included in the internship
placement. Entries should be recorded daily. A recap sheet should be developed at the end of each
week including major assignments, responsibilities, and amount of time spent in each category of
activity/responsibility.
2. A report to communicate to members of the seminar the specific operation of your placement site
including the following elements:
a. Brief review of the school district’s (or equivalent’s) comprehensive developmental
guidance program.
b. Goals and objectives of your internship experience site.
c. Methods being used to accomplish these objectives and goals.
d. Allocation of school district (or institutions setting) resources for guidance and counseling.
e. Your specific activities/responsibilities during the internship.
f. Some contribution (handout, etc.) related to your major professional interest/concern. e.g.
self esteem, decision making.
Sufficient copies of this report should be reproduced so that all members of the seminar can
be given a copy. This report is usually due when you make your presentation before the
seminar.
3. A final report due by which includes the following elements:
A brief review of the professional career significance to you of your setting and on-site supervision.
Your view of trends in school counseling and guidance based on your investigation/research, and
your personal experiences in the field.
A reconciliation of your life’s goals, values, and employment opportunities in relation to current
status and future trends in school counseling and guidance. What are your plans for the
next 5 years? For the next 10 years?
A comparison and critique of the two TEA Developmental Guidance Programs and the program at
your practicum site.
18
Counseling Program
University of North Texas
INTERNSHIP GUIDELINES
(School Counselor Candidate)
Student’s Name:
Address:
Street City Zip Code
Telephone:
Area Code Number
Internship Supervisor’s Name:
Title and/or Position:
Telephone:
Area Code Number
1. Students are to be placed in appropriate school or equivalent settings which will give them opportunities to
apply the skills and knowledge they have acquired in their school counseling preparation program.
2. The internship setting should provide the student a broad range of experiences and responsibilities.
3. The internship experience arrangement should be of such a nature as to be mutually beneficial to cooperating
professionals and students. It is expected that students will have sufficient preparation to enable them to
adjust rapidly and become productive colleagues during the period of the internship placement.
4. Students and their supervisors will be visited during the internship experience by a UNT Counseling Program
supervisor for the purpose of evaluating student progress. If progress is deemed unsatisfactory, either by the
internship supervisor or the Counseling Program supervisor, the student will be withdrawn from the
internship experience.
5. The student’s internship supervisor will be asked to complete an Evaluation Form which will be used in the
evaluation conferences with the student. The form will be provided by the University of North Texas
Counseling Program.
6. Students are expected to abide by the professional conditions in effect at the specific school/institutional
assignment.
7. The internship experience will extend from the period of:
Date
During the following days and hours:
Days Hours
Days Hours
Total clock hour commitment:
Hours
APPROVAL:
For the School: For UNT Counseling Program:
Name Name
Title Title
19
Counseling Program
University of North Texas
INTERNSHIP CONTRACT
(School Counselor Candidate)
This internship agreement between the UNT Counseling Program and clarifies the joint
and separate responsibilities of each institution for the selection and internship experiences of UNT Counseling Program
students during the academic year. (Please see Supervision Agreement form)
, as the participating School, will:
Provide field training and supervision by the school counselor at times to be agreed upon by the Counselor and the
UNT intern for approximately hours per week for weeks.
Provide such cases and student/client contacts as the School and the Counseling Program Supervisor deem
appropriate for the student’s sill level and time allotted for the internship experience.
Provide the use of existing office space, privacy for counseling, use of available equipment and usual office
supplies and clerical assistance necessary to the learning task.
Submit requested reports to provide the student’s Counseling Program Supervisor with an evaluation of the
student’s activities.
Inform the Counseling Program of changes in School policy, procedures, and personnel that might affect the
internship experience.
The University of North Texas Counseling Program, as the participating University, will:
Participate with the School in the screening and selection of the student counselors and honor a request by the
School that the student be relieved of responsibilities when and if the student is not capable of functioning at the
required level or if for any reason the student is found unsuitable for assignment in the School.
Share appropriate requested information regarding the student’s background experience and educational
accomplishments and needs.
Enforce rules and regulations governing the student that they are mutually agreed upon by the UNT and the School.
Students will be expected to abide by School office hours and personnel practices and to respect the confidential
nature of School case records.
Provide regular supervision of the student’s experiences according to the policies the Counseling Program
enforces.
School Supervisor School Principal or Director of Guidance
(Date) (Date)
UNT Supervisor Coordinator UNT Counseling Program
(Date) (Date)
20
Counseling Program
University of North Texas
SUPERVISION AGREEMENT
COUNSELING PROGRAM, UNIVERSITY OF NORTH TEXAS
AND
SCHOOL NAME
SCHOOL SUPERVISOR’S NAME:
Title:
SUPERVISOR’S HIGHEST ACADEMIC DEGREE AND MAJOR:
Professional Credentials:
STUDENT NAME:
SCHEDULE (DAYS AND TIMES WHEN THE STUDENT WILL BE AT SCHOOL):
NATURE OF THE DUTIES AND EXPECTATIONS (IN DETAIL):
SUPERVISION WILL TAKE PLACE ON: AT
Day(s) Time(s)
NUMBER OF SUPERVISION HOURS PER WEEK: INDIVIDUAL
GROUP
This agreement was developed in a conference between the student and the supervisor. Also
discussed was school policy on dress, confidentiality, files, records, office hours, and those areas
essential for job effectiveness.
SUPERVISOR STUDENT
(FOR THE SCHOOL) DATE
21
Counseling Program
University of North Texas
COUN 5720 & 5721: INTERNSHIP I & II
ETHICS AGREEMENT
&
GUIDELINES
DIRECTION:
Student is to complete this form in duplicate and submit a copy of this agreement to
the University Internship Coordinator. The 2nd copy is for your own records.
1. I hereby attest that I have read and understood the American Counseling Association
ethical standards and will practice my counseling program work in accordance with these
standards. Any breach of these ethics or any unethical behavior on my part may result in
my removal from internship, a failing grade, and documentation of such behavior will
become part of my permanent record.
2. I understand that I may be required to become familiar with additional codes of ethics from
related professional disciplines.
3. I agree to adhere to the administrative policies, rules, standards, and practices of the
Internship site.
4. I understand that my responsibilities include keeping my Internship supervisor(s) informed
regarding my internship experience.
5. I understand that I will not be issued a passing grade in Internship unless I demonstrate the
specified minimal level of counseling skill, knowledge, and competence and complete
course requirements as required.
Signature
Date
22
Counseling Program
University of North Texas
COUN 5720 & 5721: INTERNSHIP I & II
ETHICS AGREEMENT
&
GUIDELINES
DIRECTION:
Student is to complete this form in duplicate and submit a copy of this agreement to
the University Internship Coordinator. The 2nd copy is for your own records.
1. I hereby attest that I have read and understood the American Counseling Association
ethical standards and will practice my counseling program work in accordance with these
standards. Any breach of these ethics or any unethical behavior on my part may result in
my removal from internship, a failing grade, and documentation of such behavior will
become part of my permanent record.
2. I understand that I may be required to become familiar with additional codes of ethics from
related professional disciplines.
3. I agree to adhere to the administrative policies, rules, standards, and practices of the
Internship site.
4. I understand that my responsibilities include keeping my Internship supervisor(s)
informed regarding my field experience.
5. I understand that I will not be issued a passing grade in Internship unless I demonstrate the
specified minimal level of counseling skill, knowledge, and competence and complete
course requirements as required.
Signature
Date
23
Counseling Program
University of North Texas
COUN 5720 Internship I & COUN 5721 Internship II
CLOCK-HOURS SUMMARY
Name
School
Supervisor
Date Responsive Individual Guidance System Supervision Preparing Totals
Services Planning Curriculum Support Group & Training Daily
Totals
Total Client Contact Total Supervision Grand Total
24
Counseling Program
University of North Texas
COUN 5720/5721: Internship I & II
Release of Information
I hereby authorize my COUN 5720/5721 Internship Instructor to release information from my
Counseling Program student file to my Supervisor(s) at my Internship site(s). My instructor may
release to my Supervisor(s) any information that, in the judgment of my instructor, is pertinent to
my progress in Internship. This release shall be in effect only during the time I am enrolled in
COUN 5720 and/or 5721.
Name (print):
Name (signature):
Social Security Number:
Date:
25
Counseling Program
University of North Texas
INTERNSHIP EVALUATION FORM
(School Counselor Candidate)
Date:
Student:
School:
Supervisor:
Average Hours Per Week In Counseling and Related Activities:
Weekly Individual Evaluation Periods: Day(s) From To
Rating Scale: 6 - Not required and/or Not evaluated.
5 - Superior performance, not usually observed in individual with student’s
level of training and experience.
4 - Excellent performance, considering level of training and experience.
3 - Good, average performance, considering level of training and
experience.
2 - Below average performance considering level of training and
experience.
1 - Very low performance. Remediation efforts recommended.
ADMINISTRATIVE RESPONSIBILITIES
Knows and supports the District’s Comprehensive Developmental Guidance Program.
Attends staff meetings regularly and makes appropriate contributions.
Completes administrative forms correctly and promptly.
Maintains standing appointment records with secretarial staff.
Maintains good progress notes for each client.
Maintains group records. Completes group or program evaluations.
Directs attention to general administrative details.
Supervises paraprofessionals and clinical staff, as appropriate.
Participates in program evaluation.
26
Internship Evaluation Form
Page 2 of 4
SUPERVISION
Keeps supervision appointments and participates actively and willingly.
Seeks feedback and accepts suggestions and criticism well.
Is open to self-examination and overcoming personal blocks to counseling and guidance.
Is eager to learn new counseling and guidance skills and techniques.
Attends supervision meetings, presents cases, and contributes appropriately.
Demonstrates ability to evaluate counseling sessions and tapes and gain insight.
COUNSELING
Is warm, caring and empathic toward students and counselees.
Is accepting and non-judgmental toward counselees.
Is a good, active listener.
Demonstrates ability to be flexible and spontaneous during counseling and guidance
sessions.
Counsels proficiently with a variety of counselees and concerns.
Conceptualizes concerns skillfully and applies counseling and guidance techniques
according to a consistent rationale.
Demonstrates ability to apply a broad range of counseling and guidance modalities and
technique.
Is observant and insightful regarding verbal and non-verbal behaviors.
Confronts appropriately and helpfully.
6--Not Evaluated
5--Superior performance
4--Excellent performance
3--Good, average performance
2--Below average performance
1--Very low performance
27
Internship Evaluation Form
Page 3 of 4
Uses appropriate self-disclosure and sharing of feelings and experiences.
Gives positive suggestions and expectations of success to clients.
Paces and times interventions with skill.
Demonstrates skill in handling transference and countertransference issues.
Gives homework assignments when appropriate and uses resource material, including
bibliotherapy, when necessary.
Understands and appropriately uses psychometric instruments.
Completes reasonable quantity of work by counseling a sufficient number of counselees.
Demonstration of skill level:
Individual Counseling Consultation
Group Counseling Appraisal/Assessment
Group Guidance Life Career Counseling & Guidance
PROFESSIONAL RELATIONSHIPS AND STAFF DEVELOPMENT
Attends in-service training seminars, presents programs and contributes appropriately.
Demonstrates willingness to read recommended materials and to conduct relevant library
research as needed.
Is involved in seminars, workshops, or activities to enhance skills or increase base of
knowledge.
Relates well with professional and non-professional staff.
Maintains high ethical standards consistent with ACA Code of Conduct, TCA Guidelines,
and LPC rules and regulations.
Participates in professional counseling organizations.
6--Not Evaluated
5--Superior performance
4--Excellent performance
3--Good, average performance
2--Below, average performance
1--Very low performance
28
Internship Evaluation Form
Page 4 of 4
ADDITIONAL COMMENTS: (A short overall assessment statement comparing
this student with others you have supervised or your
expectations of the student and the internship will be
most helpful.)
OVERALL EVALUATION:
A clearly superior student at this level of training.
Has met the requirements of this internship in an above average manner.
Has met the requirements of this internship in a satisfactory manner.
Needs to demonstrate an improved level of functioning to be considered satisfactory.
At this time an evaluation cannot be given. (The reasons are given under additional
comments above.)
On-Site Supervisor:
Signature Date
Student:
Signature Date
29
Counseling Program
University of North Texas
SUPERVISEE’S EVALUATION OF SUPERVISOR
School Name: Supervisor’s Name:
Date:
Please respond to the following statements in regard to your reactions and feeling about your
supervisor. Complete a separate evaluation sheet for each supervisor. DO NOT SIGN YOUR
NAME. This paper will be given to your supervisor to aid his/her development as a
supervisor.
General Comments
1. Involvement Poor Outstanding
a. Demonstrates involvement and 1 2 3 4 5 6 7
seriousness about being a supervisor.
b. Is aware and involved in the 1 2 3 4 5 6 7
issues being discussed.
2. Growth
a. Uses personal experience with 1 2 3 4 5 6 7
clients to further your development.
b. Uses personal feelings and insights 1 2 3 4 5 6 7
to further your development.
3. Rapport
a. Makes it easy for you to initiate 1 2 3 4 5 6 7
communication with him/her.
b. Makes it easy to share your counseling 1 2 3 4 5 6 7
strengths and weaknesses with him/her.
4. Facilitation
Initiates helpful discussions of your 1 2 3 4 5 6 7
competencies and strengths with you.
Makes it easy to share your counseling 1 2 3 4 5 6 7
of your areas for growth.
30
Supervisee’s Eval of Supervisor
Page 2 of 2
Climate and Relationship
Poor Outstanding
1. Is comfortable in the role of supervisor. 1 2 3 4 5 6 7
2. Is open and flexible to your wants and style. 1 2 3 4 5 6 7
3. Is responsible as a supervisor. 1 2 3 4 5 6 7
4. Is accessible between sessions. 1 2 3 4 5 6 7
5. Shares and negotiates expectations of supervision. 1 2 3 4 5 6 7
6. Is willing to take risks. 1 2 3 4 5 6 7
7. Initiates a working relationship. 1 2 3 4 5 6 7
Implementation
Models specific interventions. 1 2 3 4 5 6 7
Presents alternative interventions. 1 2 3 4 5 6 7
Helps you identify movement or lack of 1 2 3 4 5 6 7
movement in the client.
Aids your conceptualization of client’s behavior. 1 2 3 4 5 6 7
Generates hypotheses about client behavior. 1 2 3 4 5 6 7
Focuses on exploration of your feelings. 1 2 3 4 5 6 7
Focuses on content of the counseling session. 1 2 3 4 5 6 7
Focuses on process of the counseling session. 1 2 3 4 5 6 7
Supervisor responses that facilitate the most growth:
Supervisor responses that facilitate the least growth:
31
Counseling Program
University of North Texas
Internship Site Supervisor’s Evaluation of Program
Please evaluate the educational program of University of North Texas Counseling Program from
your experience as a supervisor for students in Internship.
Please respond on a scale of:
1 = very poor
2 = poor
3 = average
4 = above average
5 = excellent
1. Compared to other masters degree students in Internship, University of North Texas
students overall educational preparation is
1 2 3 4 5
2. Student’s clinical skills ability
1 2 3 4 5
3. Student’s conceptualization of client or clients
1 2 3 4 5
4. Student’s ethical behavior
1 2 3 4 5
5. Student’s theoretical knowledge
1 2 3 4 5
6. Student’s administrative skills
1 2 3 4 5
7. Supervisor’s perception of support from University of North Texas Faculty and staff.
1 2 3 4 5
32
Supervisor’s Eval of Program
Page 2 of 2
8. Suggestions for program improvement:
9. Other ideas or suggestions:
Thank you for providing this valuable input for our counseling program.
Please return this form to:
UNT Counseling Program
Internship Coordinator
155 Union Circle #310829
Denton, TX 76203-5017
33
Counseling Program
University of North Texas
School Counseling
Internship Checklist
COUN 5720/5721
ALL internship forms are to be returned to the School Counselor Internship
Coordinator. Phone: 940-565-2910; Fax: 940-565-2905
Students are reminded to keep copies of each of the following in their personal file:
____ 1. Insurance verification 5720
______ 5721
_____ 2. Form from Dee Ray 5720
_____ 5721
_____ 3. Internship contract 5720
_____ 5721
_____ 4. Internship requirements 5720
_____ 5721
_____ 5. Internship guidelines 5720
_____ 5721
_____ 6. Supervision agreement 5720
_____ 5721
_____ 7. Student data sheet 5720
_____ 5721
_____ 8. Internship application 5720
_____ 5721
_____ 9. Ethics agreement & guidelines 5720
_____ 5721
_____10. Clock hours summary (600 total) 5720
_____ 5721
Refer to: A Model Development Guidance and Counseling Program Development
Pre K- 12 – State of Texas
34
Student _______________________________
_____ 11. Release of information 5720
_____ 5721
_____ 12. Supervisee’s evaluation of supervisor 5720
_____ 5721
_____ 13. Internship evaluation form 5720
_____ 5721
_____ 14. Comparison of:
A Model Developmental Guidance and Counseling Program Development
Pre K-12 the Grade Career Development Implementation Handbook:
Grades K-12
Place your name on the top right of ALL papers. All material must be received two weeks
before the end of the semester in the order listed.
___________________________________________ _______________
UNT Internship Coordinator Date
SUPERVISION THAT MUST SHOW ON YOUR CLOCK HOUR SUMMARY
15 week class 10 week summer Total
INDIVIDUAL: INDIVIDUAL:
1 hour per week of individual supervision 1.5 hours per week 15 hrs
on site = 15 hours individual
GROUP:
Group supervision on site, “ARDS”, etc=
8 hours group 8 hours group 8
Group supervision with UNT faculty (3hrs,
5 meetings) = 15 hours group supervision 15 hours 15
On-site group supervision (1 hr, 2 meetings) 2 hours 2
35
TASK ANALYSIS LOG
COUN 5720-5721
Guidance Curriculum Responsive Services Individual Planning Systems Support Non-guidance
Administrative
Activities
Provide guidance content Addresses the immediate Assists students in monitoring Include program and staff
in a systematic way to all concerns of students and understanding their own support activities and
students development services
35-45% 30-40% 5-10% 10-15%
Purpose: Purpose: Purpose: Purpose:
Awareness, skill Prevention, intervention Student planning and goal Program delivery and
development, and setting support
application of skills needed
in everyday life
Classroom activities, group Consultation, personal Individual assessment, test Consultation, professional Bus duty, lunchroom
guidance activities, counseling, crisis counseling, interpretation, placement, development, committee/ duty, playground duty,
consulting with teachers small groups, individual vocational/occupational advisory boards, comm- balancing class size,
about classroom guidance counseling, referral exploration unity involvement, building master
Four year plan (group or programs, management, schedule, substitute
individual), behavior parent education, testing teaching, lunch break
management planning program
Areas Addressed: Areas Addressed: Areas Addressed: Areas Addressed:
Self confidence Academic concerns, school Educational acquisition of study Guidance program
development, motivation to related concerns - tardiness, skills, awareness of educational development, parent
achieve, decision-making, absences & truancy, opportunities, appropriate education, teacher/
goal setting, planning and misbehavior, school course selection administrator consultation
problem solving skills avoidance, drop-out
Interpersonal Relationship concerns, Lifelong learning, utilization of
effective-ness (including physical/sexual/emotional test scores, career - knowledge
social skills) abuse as described in Texas of potential career opportunities,
communication skills, Family Code, grief/ loss, knowledge of career and
cross-cultural substance abuse, family technical training, know-ledge of
effectiveness, responsible issues, harassment, coping positive work habits,
behavior, classroom and stress, parent consult, personal/social - development
guidance new student of healthy self-concern,
development of adaptive and
adjustive social behavior
36
Last Page of School Internship Packet
8/08
37