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					                                  CC Site Supervisor Manual
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    Georgia Southern University
       College of Education




  Community Counseling Program




       Internship Manual for
          Site Supervisors




COUN 7738: Counseling Internship I
COUN 7739: Counseling Internship II




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                           TABLE OF CONTENTS


I.     Internship General Description ……………………………………….. p. 4

II.    Course Outline …………………………………………………………. p. 4

III.   CACREP Standards ……………………………………………………. p. 6

IV.    Guidelines and Policies ………………………………………………... p. 7

V.     Procedures………………………………………………………………. p. 8

VI.    Counseling Forms……………………………………………………….. p. 14
       Analysis of Counseling Session
       Client Release Form
       Parental Release Form

VII.   Forms to be Submitted to University Supervisor…………………….. p. 16
       Internship Request Form
       Information Data Sheet
       Objectives for Internship


VIII. Forms to be Signed and Submitted to University Supervisor………... p. 17
      Counseling Internship Agreement (4 copies needed)
      Student Internship Agreement (2 copies needed)
      Internship Time Sheet (1 copy needed for each month)
      Checklist for monthly activities



IX.    Evaluation Forms……………………………………………………….. p. 24
       Site Evaluation Form
       Intern Performance Evaluation
       Intern Evaluation of Supervisor




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To the Community Supervisor:

We appreciate your willingness to serve as a supervisor for an intern from the
Community Counselor program at Georgia Southern University. It is our intent to
provide you with an intern who is well prepared and an appropriate placement for your
agency. With the team approach between yourself, the intern, and the University
Supervisor, we trust the experience will be both positive and productive. We understand
how busy you are, however, we ask you to carefully read the following pages to ensure
we are all in agreement about the objectives, procedures, and attitudes that will make the
internship process successful.

The Community Counseling Internship Manual for Site Supervisors has been designed to
provide Internship site supervisor’s detailed and relevant information about field
experiences for the Community Counseling program in the department of Leadership,
Technology, and Human development (LTHD) at Georgia Southern University. The
counseling faculty considers these field experiences to be among the most important for
our community counseling students. We hope this manual will be helpful in answering
some commonly asked questions about Internship.


Again, thank you for your participation in this experience to help Georgia Southern’s
                                                    st
community counselors-in-training to work in the 21 Century as professional counselors.




Website: http://coe.georgiasouthern.edu/lthd/counselored.html




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Description of Internship

COUN 7738 & 7739
The Internship is an intensive field-based experience for candidates in the master’s
degree program in community counseling. Community counselors-in-training will
integrate advanced competencies and knowledge with professional supervision.
Placements occur in both public and private agency settings. Application for the
internship and approval for placement are required prior to registration. A minimum of
six hundred (600) hours in internship placement is required. The grading system is
credit/no credit. Prospective interns needed to have completed the COUN 7737 Practicum
course before beginning the internship. Internship is normally taken at or near the end of
the program of study, after the Practicum experience.

Master’s Degree in Education emphasis in Community Counseling

The Community Counseling Program provides competencies for entry-level positions as
professional counselors in community agency settings. Upon completion of the graduate
program of study, students complete all academic requirements for licensing as a
Licensed Professional Counselor. In addition to coursework in core counseling skills,
process, and theory, specialized coursework focuses on addiction counseling, family
counseling, assessment, implementation and evaluation of counseling programs, ethical,
legal, and professional issues in community counseling.


Following are the courses a student must complete to earn the Master’s Degree:

1) Foundations of Community Counseling
   and Ethics
2) Group Dynamics
3) Family Counseling
4) Theories of Counseling
5) Counseling Assessment, Diagnosis and
   Intervention
6) Models/Techniques of Counseling
7) Addiction Counseling
8) Practicum in Counseling
9) Career Counseling
10) Counseling Internship
11) Cross Cultural Counseling
12) Counseling Internship
13) Life Span Development
14) Learning Theories &Applications
15) Individual Analysis
16) Educational Research




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More information about the program is available on the Counselor Education website at:
www.georgiasouthern.edu/lthd/counselored ; or call the departmental office at (912) 478-5307.




                            Student Intern Time Commitment for Internship I and II

                                   Internship I                   Internship II
1. Direct Service – 240 hrs        120 in an agency setting       120 in an agency setting
2. Supervision On-Site– 30 hrs     1 hour per week (15 weeks)     1 hour per week (15 weeks)
3. University Supervision- 45hrs   1 ½ hours per week (15)        1 ½ hours per week (15)
4. Other Hours – 385hrs            192 ½ hours                    192 ½ hours

Total Hours for two internships: 600

1. Direct Service:
Hours include individual, group and family counseling, prevention activities, advocacy and consultation. As well as
counting the intern’s own service, they may also receive direct service hours when the intern is observing someone else
conducting these activities.

2. Site Supervision:
At least one hour of supervision per week must be face-to-face one hour individual supervision between the site
supervisor and the intern. Georgia Southern strongly recommends these meetings occur in a quiet office without
interruption.

3. University Supervision:
The intern is required to attend a Counseling Internship class for the academic year. The intern may count the hours as
listed above.

4. Other Hours:
These hours include professional development activities, additional training experiences, any related readings, duty at
other on-site and agency community activities (e.g. community service board /collaborative meetings, open houses, etc.).
Internship class but may not count as direct service hours until the university internship class begins (under direct
University supervision). Students are expected to remain at their placement sites for the entire school term. The number of
hours spent at the intern’s site varies according to the needs of the site and the students. Typically, interns can expect to
spend about 20 hours per week at each site.




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CACREP Standards

The Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards are the
guidelines for use in implementing internship. Because Georgia Southern University’s school counseling
program is designed to meet CACREP standards, it is essential that both the internship site and the overall
internship experience adhere to the following standards.

The CACREP standards require a supervised internship of 600 clock hours, which include the following:

1. A minimum of 240 hours of direct service with clients appropriate to the program of study,

2. A minimum of one hour per week of individual supervision throughout the internship performed by the on-
    site supervisor,

3. A minimum of one and one-half hours per week of group supervision provided on a regular schedule
    throughout the internship, usually performed by a program faculty member,

4. The opportunity of the counselor-in-training to become familiar with a variety of professional activities other
    than direct service,

5. The opportunity for the counselor-in-training to develop audio and/or videotapes of the student’s interactions
    with clients appropriate to the specialization for use in supervision,

6. The opportunity for the counselor-in-training to gain supervised experience in the use of a variety of
                professional resources such as assessment instruments, computers, print and non-print media,
                professional literature, research, and information and referral to appropriate providers,

7. A formal evaluation of performance during internship by a program faculty supervisor in consultation with
    the site supervisor.

Council for Accreditation of Counseling and Related Educational Programs (CACREP).
      (2001). The 2001 standards [Electronic version]. Retrieved July 27, 2008, from
       http://www.cacrep.org/2001Standards.html




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CACREP curriculum area standards are identified as:

1. Human Growth and Development: Completion of the program will provide the student an understanding of
the major theories of human growth and development; how human behavior and environmental factors affect
both normal and abnormal behavior in both the school and community agency setting.

2. Social and Cultural Foundations: Completion of the program will provide the student an understanding of
issues and trends in a multicultural and diverse society. These considerations are based upon human attitudes
and behavior toward such factors as age, race, religious preference, physical disability, sexual orientation,
ethnicity and culture, family patterns, gender, socioeconomic status, and intellectual ability.

3. Helping Relationships: Completion of the program will provide the student an understanding of counseling
and consultation processes such as basic interviewing, assessment, and counseling skills. Other helping
considerations include knowledge of counselor, consultant, and client characteristics; as well as behaviors that
influence the helping process.

4. Group Work: Completion of the program will provide the student an understanding of group development,
dynamics, counseling theories, group counseling methods and skills, and other group work approaches.

5. Lifestyle and Career Development: Completion of the program will provide the student an understanding of
career development and related life factors such as the career decision-making process and interrelationships
among work, family and other life roles including multicultural and gender issues as related to career
development.

6. Appraisal: Completion of the program will provide the student an understanding of individual and group
approaches to assessment and evaluation.

7. Research and Evaluation: Completion of the program will provide the student an understanding of types of
research methods, basic statistics, and ethical and legal considerations in research.

8. Professional Orientation and Ethics: Completion of the program will provide the student an understanding of
all aspects of professional functioning including history, roles, organizational structures, ethics, standards, and
credentialing.

9. Specialization: Completion of the program will provide the student knowledge and competence in the basic
skills for entrance into the counseling profession specialization of his or her program.




For your information, the intern will evaluate their site placement and supervision.


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                                           The Role of the Supervisor

The mindset and functions of a supervisor are similar to but not the same as a counselor. Indeed, your role will
be unique, as it pertains to:
       1) Your background, expertise, and personal approach;
       2) The background, expertise, and personal approach of the intern (he/she may
          already have had counseling experience – or may still be in the process of
          identifying a ―style‖ as a counselor);
       3) And the particular circumstances of your agency setting (size; demographics;
          counselor/client ratio; administrative and other support; special needs;
          and other factors).

The supervisor plays three roles:
      1) Counselor – participating with the intern in self-exploration; establishing
          distance; becoming aware of one’s values and possible biases; and confronting
          the range of emotions that inevitably occur.
      2) Teacher – imparting new knowledge; refining skills as requested by the intern
          or as the occasion calls for; inquiring about the cognitive theoretical orientation
          of the intern; demonstrating by example as a role model; assuring the intern has a
          range of experiences; and observing and providing feedback on performance.
      3) Consultant – meeting weekly with your intern, responding to intern special
          request for a conference to discuss a specific counselee, or approach/ technique
          the intern utilized; emphasizing on professional commitment and improvement.

Site Supervisor Responsibility Checklist

   1. Submit a copy of your license/certificate to the Clinical Coordinator to verify you meet
      the criteria for selection as a site supervisor.
   2. Sign the agreement form (to be provided by intern) and provide a copy of your resume
      to the Clinical Coordinator (your intern can deliver it) within two weeks of
      placement of the intern at your site.
   3. Meet one hour face-to-face each week with your counselor intern in a quiet and
      uninterrupted location.
   4. Attend all supervisor trainings. The Georgia Southern University Counselor Education
      Program offers training in supervision for site supervisors each semester.
   5. Complete the Site Supervisor and Director’s Evaluations of Counseling
      Intern’s Performance to indicate your professional assessment of the counseling intern’s
      demonstrated knowledge, skills, and competencies. Review them with the intern.
   6. Each month review the Internship Time Sheet that the counseling interns will be
      required to fill out. Please sign to confirm your concurrence.
   7. Provide experience for the counseling intern to job shadow you and other key faculty
      members.




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   8. Provide the intern with experience in co-leading and leading individual, psycho-educational,
      and group counseling activities. Provide feedback to intern based on your observations.
   9. Provide the intern with experience in observing and conducting consultation sessions
      with staff, other agencies, and community representatives.
  10. For your information, the intern will evaluate their site placement and supervision
      experience at the end of the year. Georgia Southern University will use this information to evaluate the
      effectiveness of the placement and address concerns. You will find a Site Evaluation Form and a Student
      Counselor Evaluation of Supervisor in the Student Internship manual.



                                 Suggestions for Interns Transitioning to the Site

Site Supervisor will introduce intern to:

�� Agency and unit personnel
��Key staff members
�� Administrative team
�� Staff (who will assist with coordination of referrals, communications, etc.)
�� Other community resources or individuals who are interactive with the agency


Site Supervisor the Intern will assist with:

�� Clinical observations
�� ―Team‖ counseling in the beginning
�� Intern observing (―shadowing‖) other counselors and key personnel
�� Development of groups with the intern as co-facilitator (e.g. psycho-educational, divorce, a, eating disorder, sexual
 minority, etc.)
�� Attaining an intern caseload
�� Individual counseling (beginning early on with consultation/supervision around each session…daily ―debriefing‖)
�� Within 4 to 6 weeks, intern working independently with clients and groups in consultation with site supervisor


Site Supervisor will address:

�� Personal/social counseling…how/what
��Treatment planning…how/what
�� Counseling assessment
�� Crisis Intervention…who/how/what
�� Carefully outline procedures for special needs referrals and assistance
�� Policies and Procedures for the agency (e.g. mandatory reporting)
�� Importance of understanding the agency and the ―political climate‖
�� Role of the counselor within the agency (e.g. treatment team, staffing, advocacy etc.)
�� Role of the counselor and unit with administrative team and staff
�� Obtaining of resources…within the agency and from the community




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Supervisor will provide:

�� One-on-one weekly supervision—one hour uninterrupted
�� Physical area for individual counseling, and mailbox for agency communications
�� Clear understanding of weekly supervision time, criteria, method
�� Calendar of agency activities (e.g. staffing, counselor meetings, staff meetings, meetings with Community Service
 Boards /collaboratives)
�� Counseling time management strategies and prioritization strategies for daily activities
�� Regular feedback on counseling activities…immediately and during weekly supervision…be specific…while allowing
 the intern to ―brainstorm‖ what went wrong, what they would change, what was good.
�� A packet with all agency forms (e.g. referral, reporting, client information) and Employees Handbook.
�� Clear agreement around days of week for intern at site, time for supervision, preparation needed for supervision (e.g.
 lists, video, questions/concerns).
�� Clear understanding of expectations for growth and individuality
�� Awareness of agency collaboratives/ partnerships.

Additional hints for Site Supervisors and interns:
�� Discuss diversity and cultural issues of agency and community…be clear and specific
�� Introduce resources frequently utilized
�� Do home visits (if appropriate)


                                            Communication and Evaluation

You are encouraged to communicate with the University supervisor as frequently as you think is appropriate, by
telephone, e-mail, or personally. Ideally, we would enjoy connecting every three weeks or so. At supervisor seminars, you
will be asked to:
         1) Review briefly your counseling program,
         2) Share your philosophy and approach to the supervision of counseling interns, including ―success stories‖,
         3) Raise general and specific questions regarding effective approaches/methods to use in difficult situations,
         4) Suggest ways the counseling program in general, and the internship process in particular, could be
            strengthened,
         5) Raise other issues which you believe to be pertinent, and
         6) Read and discuss current literature/research on the role of the community/mental health
            counselor.


                                                             ****
The following section outlines a remediation process to be used if the intern requires significant changes in personal
and/or professional behavior. The counseling faculty will be fully supportive of the agency supervisor and the intern in
arriving at the most beneficial solution for all individuals who are involved.


                                         Remediation Tips for Your Intern

1) Address your concerns immediately. Do so in a caring and concerned manner, offering the intern time for reflection
   and the opportunity to arrive at an alternative option.
2) Set a plan for correction if necessary. Make sure the intern is clear about expectations and steps for corrections.
3) Make the plan with the intern and brainstorm various solutions.
4) Develop short-term goals/objectives for the problem.
5) Develop long-term goals/objectives for the problem.
6) Put the plan in writing to be shared with the intern.
7) Include in the plan details for remedial supervision if necessary.
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 8) Include in the plan how attainment will be demonstrated/documented.
 9) If the above procedures are not working or other difficulties are becoming apparent, notify the University supervisor
     IMMEDIATELY. Schedule a time for the university supervisor to visit first with you, and then with you and the
     intern.
10) Georgia Southern wants the internship experience to be beneficial for both you and the intern. Therefore, please notify
     the university supervisor immediately of concerns.




                                             Criteria for Selection of Supervisor

A. Recognition of excellence in counseling from administrators, peers, and clients.
B. Commitment to quality.
C. Understanding of counselor’s role as supportive of the learning process.
D. Mature understanding of themselves as counselors, with sense of own professional efficacy and uniqueness.
E. Clear philosophy of counseling and learning.
F. Knowledge about, and respect for, the intellectual and social development of their clients, including differences and
   similarities because of gender, race, ethnicity, social class, exceptionality, disabilities, linguistic experience, and sexual
   orientation.
G. Interest in participating and committing time to the program.
H. At least Master’s Degree in Counseling or counseling related area.
I. At least three years of post-degree experience.
J. Experience in supervising students.
K. Familiarity with the Georgia Southern University Counseling Internship Manual.
L. Familiarity with, and implementation of the AMHCA (2000) and the ACA (2005) Codes of Ethics.
M. A current copy of the site supervisor’s résumé must be on file at Georgia Southern University Counseling Program
    within two weeks of your intern’s arrival.

                                                           Finally….

University Supervisor Responsibilities

(1) Minimum of two site visits per semester;
(2) Small group supervision with intern;
(3) Video/audio tape review;
(4) Semester assessment of intern;
(5) Review of intern’s organizational analysis and data based intervention projects; and
(6) Support for both the intern and site supervisor during the year.




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                           CACREP Standards for Community Counseling Programs


In addition to the common core curricular experiences outlined in Section II.K, the following curricular experiences and
demonstrated knowledge and skills are required of all students in the program. Link to CACREP 2001 Standards -
http://www.cacrep.org/2001Standards.html

A.   FOUNDATIONS OF COMMUNITY COUNSELING

     1. Historical, philosophical, societal, cultural, economic, and political dimensions of and current trends in the
        community human service/ mental health movement;

     2. Roles, functions, preparation standards, credentialing, licensure and professional identity of community
        counselors;

     3. Policies, laws, legislation, recognition, reimbursement, right-to- practice, and other issues relevant to
        community counseling;

     4. Ethical and legal considerations specifically related to the practice of community counseling (e.g., the ACA
        Code of Ethics); and

     5. The role of racial, ethnic, and cultural heritage, nationality, socioeconomic status, family structure, age, gender,
        sexual orientation, religious and spiritual beliefs, occupation, and physical and mental status, and equity issues in
        community counseling.

B.   CONTEXTUAL DIMENSIONS OF COMMUNITY COUNSELING

     1. The roles of community counselors in various practice settings and the relationships between counselors and
        other professionals in these settings;

     2. Organizational, fiscal, and legal dimensions of the institutions and settings in which community counselors
        practice;

     3. Strategies for community needs assessment to design, implement, and evaluate community counseling
        interventions, programs, and systems; and

     4. General principles of community intervention, consultation, education, and outreach; and characteristics of
        human services programs and networks (public, private, and volunteer) in local communities.




C.   KNOWLEDGE AND SKILL REQUIREMENTS FOR COMMUNITY COUNSELORS

     1. Typical characteristics of individuals and communities served by a variety of institutions and agencies that offer
        community counseling services;

     2. Models, methods, and principles of program development and service delivery for a clientele based on
        assumptions of human and organizational development, including prevention, implementation of support groups,
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        peer facilitation training, parent education, career/occupational information and counseling, and encouragement of
        self-help;

     3. Effective strategies for promoting client understanding of and access to community resources;

     4. Principles and models of biopsychosocial assessment, case conceptualization, theories of human development and
        concepts of normalcy and psychopathology leading to diagnoses and appropriate counseling plans;

     5. Knowledge of the principles of diagnosis and the use of current diagnostic tools, including the current edition of
        the Diagnostic and Statistical Manual;

     6. Effective strategies for client advocacy in public policy and other matters of equity and accessibility;
        and

     7. Application of appropriate individual, couple, family, group, and systems modalities for initiating, maintaining,
        and terminating counseling, including the use of crisis intervention, and brief, intermediate, and long-term
        approaches.

D.   CLINICAL INSTRUCTION

       For the Community Counseling Program, the 600 clock hour internship (Standard III.H) occurs in a community
       setting, under the clinical supervision of a site supervisor as defined by Section III, Standard C.1 - 2. The
       requirement includes a minimum of 240 direct service clock hours.

       The program must clearly define and measure the outcomes expected of interns, using appropriate professional
       resources that address Standards A, B, and C (Community Counseling Programs).




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                                          GEORGIA SOUTHERN UNIVERSITY
                                         COUNSELOR EDUCATION PROGRAMS

         Application For: COUN 7738 (Internship 1) ______                            COUN 7739 (Internship II) ______

This application must be received by Internship Coordinator the semester prior to beginning your internship. A
clinical agreement must be processed for you before you begin your internship. You will be asked to provide
evidence of liability insurance and to inform the Internship Coordinator of any changes in your internship plans.
Purchase your "Internship Packet" at Printing Services, Williams Center.
Name: ____________________________________________________________________                        SS#: _____________________________

Address: __________________________________________________________________                   Phone #: ___________________________

          _________________________________________________________________                   Work #: ____________________________

Semester you will complete Counseling Practicum (COUN 7737): __________________________                        Semester, 200_________

Total number of semester hours you will have completed prior to beginning internship: __________________________________________

Check COUN courses completed:           7331      7332          7336      7335      7337      7334      7333      7737

Check one: I am completing a degree ____________________________; adding certification ____________________________

Please indicate your primary interest area:        School Counseling        Community or Agency Counseling        Higher Education



If School Counseling, Grade level(s) Preferred:    Elementary           Middle       High Community

Today's Date: ____________________________        Plan to begin internship: ____________________________ Semester, 20__________

Number of semesters anticipated for internship?      one         two       other

Internship Site Information: (Note: Complete a separate form for each site.)

System Superintendent or Agency Director to whom Clinical Contract should be mailed (not building principal):

Name: ___________________________________________________________________ Title: _________________________________

Phone #: (_____)________________________________________ Fax #: (_____)____________________________________________

Address: _______________________________________________________________________________________________________

         _______________________________________________________________________________________________________
          City                          State                                 Zip                    County

Name of Internship Site: _________________________________________________________________________________________

Internship Site Address: __________________________________________________________________________________________

On-Site Supervisor (Counselor): Name: _____________________________________________________________________________

Position: ______________________________________ Phone # (at work): ________________________________________________

Graduate Degree and Field: ________________________________________________________________________________________

Date              Received                by               Internship              Coordinator:             _________________________


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                        Georgia Southern University
                        Counselor Education Program

                            Counseling Internship
                             (COUN 7738/7739)
                               Information Data Sheet

INTERN

Name: _______________________________________________________________________

Home Address: ________________________________________________________________

Name of Agency: _______________________________________________________________

Agency Address: _______________________________________________________________

Phone: Home: ____________________________ Agency: ______________________________

      Mobile: ___________________________ Work: _______________________________

E-Mail Address: _______________________________________________________________

DIRECTOR
Name: _______________________________________________________________________

Agency Address: _______________________________________________________________

Fax #: _______________________________________________________________________

SPONSORING COUNSELOR

Name: _______________________________________________________________________


Agency Address: _______________________________________________________________

Sponsoring Counselor’s Phone: _____________________________________________

E-Mail Address: _______________________________________________________________




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                           Georgia Southern University
                          Counselor Education Program

                                    Counseling Internship
                                     (COUN 7738/7739)

                              Objectives for Internship

Intern's Name: ________________________________________________ Date: ____________

Community:
_______________________________________________________________________

List below your:
        Objectives for Internship
        Criteria for Attaining these Objectives
        Intended Method of Documentation
        Date of Attainment

Your objectives must fall within the following areas of counseling:
      Program Development             Prevention     Counseling Consultation
      Professional Activities         Assessment Advocacy




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                            Georgia Southern University
                            Counselor Education Program

                           Counseling Internship Agreement

The Counselor Education Internship experience is a cooperative effort involving the
agency director, the sponsoring counselor, the counselor intern, and the Georgia Southern
University supervisor/instructor. The Internship experience will be effective if those
involved understand and accept the following responsibilities:

Responsibilities of the Director:

a. Allow the intern access to clients a minimum of 1 to 2 hours in the regular daily
   schedule for counseling and activities.

b. Permit the intern to attend appropriate conferences.

c. Encourage in-service training activities and opportunities with professional staff.

d. Make provisions for facilities and materials to be used by the intern.

e. Support the opportunity for intern audio/visual taping of taping of selected
   counseling sessions

f. Review and sign the intern's monthly time sheet.

Responsibilities of the Site Supervisor:

a. Provide the intern with an overall orientation to the agency's specific services
   necessary for the implementation of the internship experience.

b. Provide professional assistance to the intern in attaining the internship objectives.

c. Attend, when possible, professional meetings and conferences with the intern.

d. Acquaint the intern with agency procedures dealing with crisis situations.

e. Assist the intern in attaining permission for taping selected counseling sessions

f. Make provisions for the intern to tape selected counseling sessions.

g. Review and sign the intern's monthly time sheet.



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h. Complete the evaluation form, in cooperation with the agency director, once per
   semester.

Responsibilities of the Counselor Intern:

a. Secure the approval of the Community Agency Director to participate in the counselor
   education internship.

b. Make arrangements with a qualified Community counselor to serve as your
   sponsoring counselor or site supervisor.

c. Work cooperatively with the agency director, site supervisor, and the university
   supervisor in planning the objectives and the means of attaining the objectives in the
   internship experience.

d. Assist in making arrangements for the university supervisor to visit the agency and
   meet with the site supervisor.

e. Attend conferences that are considered important by the site supervisor and the
   university supervisor.

f. Affiliate with: The American Counseling Association (ACA), The Licensed
   Professional Counselors Association of Georgia, American Mental Counselor
   Association (AMHCA).

g. Prepare and submit to the university supervisor a monthly time sheet.

h. Take advantage of the many opportunities for professional improvement during the
   internship experience.

i. Complete end of semester evaluations.

Responsibilities of the University Supervisor:

a. Assist the intern in planning for the internship experience.

b. Assist the intern and site supervisor in formulating the internship objectives.

c. Make periodic visits to the intern’s agency.

d. Work with the intern and the agency to make the internship experience as meaningful
   and as purposeful as possible.

e. Assist the sponsoring counselor in providing support for the counselor intern.

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f. Assist each counselor intern in continually evaluating his/her progress in the
   internship experience.



Acceptance

I agree to accept the above stated responsibilities involved in this internship experience.

_________________________________________                _________________
Agency Director                                          Date

_________________________________________                _________________
Site Supervisor                                          Date

_________________________________________                _________________
Counselor Intern                                         Date

_________________________________________                _________________
University Supervisor                                    Date




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                       STUDENT INTERNSHIP AGREEMENT


DIRECTIONS: Student is to complete this form in duplicate and submit a copy of this
agreement to the university supervisor.


       A. I hereby attest that I have read and understand the American Counseling Association
          ethical standards and will practice my counseling in accordance with these standards.
          Any breach of these ethics or any unethical behavior on my part will result in my
          removal from Internship and a failing grade, and documentation of such behavior
          will become part of my permanent record.

       B. I understand that my responsibilities include keeping my Internship supervisor(s)
          informed regarding my Internship experience.

       C. I agree to adhere to the administrative policies, rules, standards, practices of the
          internship site.

       D. I understand that I will note be issued a passing grade in Internship unless I
          demonstrate the specified level of counseling skill, knowledge, competence and
          complete the course requirements.




       Signature _____________________________________

       Date _________________________________________




                                                                             Revised August, 2008
                                                                    CC Site Supervisor Manual
                                                                                          21

                             INTERNSHIP TIME SHEET

Directions:

 1. Record the dates of each week.
 2. Record the total number of hours per week for each activity under the appropriate column.
 3. Total the number of hours for the week at the bottom of the week's column.
 4. At the end of the month, total the hours spent in each activity by adding the hours across
    each activity; indicate the total in the monthly columns.
 5. Submit to site supervisor and director for signature.
 6. Submit one copy to university supervisor each month and keep one copy for own records.


 Activities           Week I     Week 2         Week 3         Week 4          Monthly
                      From:      From:          From:          From:           totals
                      To:        To:            To:            To:
 Orientation
 Intake Interview
 Individual
 Counseling.
 Group Counseling
 Vocational/ career
 counseling


 Advocacy/
 Networking
 Professional
 Development
 Self-improvement
 Testing
 Administering
 Interpret Tests
 Use of Technology
 Program
 Coordination
 Consultation/
 Collaboration

 Administration/
 Staff
 Team Processes
 Site Supervision
 Other
 Weekly Totals

                                                                          Revised August, 2008
                                                                      CC Site Supervisor Manual
                                                                                            22

Interns Name ________________________________________ Date
___________________________________
Site Supervisor's Signature _____________________________ Date
___________________________________
Director's Signature __________________________________ Date
___________________________________




                             Georgia Southern University
                             Counselor Education Program

                                 Checklist for monthly activities

Activities:

Orientation to Internship Site:

Individual Counseling Sessions:
Personal/Social concerns, Academic concerns, Career concerns,

Group Counseling Sessions

Psychoeducational Group Sessions

Conflict management/peer facilitation

Consultations:
Other specialist, families, agencies

Testing:
Administration and interpretation

Community Activities:
Talks/presentations

Professional Self-improvement:
Attending staffing and treatment meetings, conferring with on-site counselor, conferring with
university supervisor, reading articles and books on guidance and counseling (may not exceed 25
hours for total internship)

Activities with Community Staff and Administration:
In-service/staff development sessions, faculty support group, create newsletter

Program Coordination:

                                                                           Revised August, 2008
                                                                       CC Site Supervisor Manual
                                                                                               23
Collecting data and information, allocating materials and resources, scheduling and organizing
meetings, developing and operating special events and programs, paperwork

Other:
New student orientation, GCIS, Creating a website




                                                                          Revised August, 2008
                                                                      CC Site Supervisor Manual
                                                                                            24
                           Georgia Southern University
                           Counselor Education Program

                                 Site Evaluation Form
Directions: Student completes this form at the end of the Internship. This should be turned into
the university supervisor.

Name ____________________________________ Site _______________________________

Dates of Placement _________________________ Director ___________________________

Site Supervisor ________________________________________________________________

Rate the following questions about your site and experiences with the following scale:

A- Very Satisfactory B- Moderately satisfactory C- Moderately unsatisfactory D- Very
Unsatisfactory

1.   ____   Amount of on-site supervision
2.   ____   Quality and usefulness of on-site supervision
3.   ____   Usefulness and helpfulness of faculty supervisor
4.   ____   Usefulness and helpfulness of group supervision
5.   ____   Relevance of experience to career goals
6.   ____   Exposure to and communication of agency’s goals
7.   ____   Exposure to and communication of agency’s procedures
8.   ____   Exposure to professional roles and functions within the agency
9.   ____   Rate all applicable experiences that you had at your site

               ____    Intake interviewing
               ____    Administration and interpretation of tests
               ____    Individual Counseling
               ____    Group Counseling
               ____    Consultation
               ____    Career Counseling
               ____    Collaboration with staff and administration
               ____    Other

10. ____     Overall Evaluation of the site
11. ____     Overall Evaluation of on-site supervisor

Comments: Include any suggestions for improvements




                                                                             Revised August, 2008
                                                                           CC Site Supervisor Manual
                                                                                                 25
                        Georgia Southern University
                   INTERN PERFORMANCE EVALUATION

Student: ________________________________________ Date: ________________

Supervisor: ____________________________________________________________

Site: __________________________________________________________________

Semester: Fall  Spring           Intern’s final term at site?    Yes         No 

        Internship I:             Internship II :               Internship I and II: 

The site supervisor should complete this form at the end of each semester. Circle the number to
the right of each item that best describes your perceptions of the intern’s skill compared to all
other people you have trained at the same level of professional development. If the current
evaluation if for the intern’s final term at the site, it should be treated as a summative evaluation.
(The term ―client‖ as used herein refers to any person receiving services including students,
parents, or teachers.)

                                                IO = Inadequate Opportunity to Observe
                                                NR = Not Relevant to the Setting

                Counseling Skill                Clearly       Clearly           Clearly
                                                Deficient     Adequate         Excellent
                 Competency
                                                1       2         3        4        5      IO   NR
1. Establishes a working relationship with
                                                1       2         3        4        5      IO   NR
    clients and gains client confidence.
2. Facilitates the client expression of
                                                1       2         3        4        5      IO   NR
    concerns.
3. Establishes relevant counseling goals        1       2         3        4        5      IO   NR
    with client.
4. Implements an intervention strategy
                                                1       2         3        4        5      IO   NR
    consistent with client information and
    goals.
5. Evaluates client progress with respect       1       2         3        4        5      IO   NR
    to goals.
6. Facilitates the client’s resolution of
                                                1       2         3        4        5      IO   NR
    concerns.
7. Appropriately refers and terminates
                                                1       2         3        4        5      IO   NR

                                                                                   Revised August, 2008
                                                                   CC Site Supervisor Manual
                                                                                         26
    clients.
8. Understands theoretical principles as      1      2      3     4     5   IO    NR
    applied to particular client problems.
9. Understands diverse cultural, ethnic,
                                              1      2      3     4     5   IO    NR
    sexual and social backgrounds and
    values.
10. Demonstrates ethical behavior in the
                                              1      2      3     4     5   IO    NR
    counseling activity and case
    management.
                                              Clearly     Clearly    Clearly
        Supervision Competency                Deficient   Adequate Excellent
                                              1       2     3      4     5 IO     NR
1. Meets with supervisor as scheduled.        1       2     3      4     5   IO   NR
2. Engages in open, comfortable and clear
   communication with peers and               1      2      3     4     5   IO    NR

   supervisors.
3. Accepts and uses constructive feedback
   to enhance self-development and            1      2      3     4     5   IO    NR

   counseling skills.
4. Uses supervision constructively.           1      2      3     4     5   IO    NR
5. Open to growth and learning.
                                              1       2     3      4     5   IO   NR
                                              Clearly     Clearly    Clearly
  Case Management Skill Competency            Deficient   Adequate Excellent
                                              1       2     3      4     5 IO     NR
1. Knows community resources.                 1       2     3      4     5   IO   NR
2. Appropriately uses referrals within and
   outside the site                           1      2      3     4     5   IO    NR

3. Responsibly schedules and meets with
                                              1      2      3     4     5   IO    NR
   clients.
4. Keeps adequate and timely client
                                              1      2      3     4     5   IO    NR
   records.
5. Consults with other staff regarding
                                              1      2      3     4     5   IO    NR
   client needs.
6. Fulfills administrative responsibilities
                                              1      2      3     4     5   IO    NR

                                                                        Revised August, 2008
                                                                    CC Site Supervisor Manual
                                                                                          27
   of the position.




                                            Clearly     Clearly    Clearly
      Community Counseling Skill            Deficient   Adequate Excellent
           Competency                       1       2     3      4     5 IO        NR

1. Demonstrates appropriate and effective
                                            1       2      3       4     5    IO   NR
   treatment planning, assessment, and
   diagnostic skills.

2. Demonstrates effective individual        1       2      3       4     5    IO   NR
   and group counseling skills.

3. Demonstrates appropriate                 1       2      3       4     5    IO   NR
   advocacy skills.

4. Demonstrates an understanding            1       2      3       4     5    IO   NR
   of family systems.

5. Demonstrates an understanding            1       2      3       4     5    IO   NR
   of working with addictions.




Based on your experiences, what would you evaluate as being the student’s major strengths?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________



                                                                         Revised August, 2008
                                                        CC Site Supervisor Manual
                                                                              28
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________




Suggestions for further professional development:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________




                                                               Revised August, 2008
                                                                       CC Site Supervisor Manual
                                                                                             29
_________________________________________                            __________________
Signature of Site Supervisor                                         Date


_________________________________________                            __________________
Signature of Faculty Supervisor                                                  Date


My signature indicates I have read and discussed the material above with my site and
faculty supervisors. It does not indicate my total or partial agreement with the evaluation.




_________________________________________                            __________________
Signature of Intern                                                  Date




                                                                             Revised August, 2008
                                                                     CC Site Supervisor Manual
                                                                                           30
                     INTERN EVALUATION OF SUPERVISOR*

Suggested Use: The practicum or internship supervisor can obtain feedback on the supervision
by asking student counselors to complete this form. The evaluation could be done at midterm
and/or final. The purposes are twofold: (1) to provide feedback for improving supervision and
(2) to encourage communication between the supervisor and the student counselor.

Directions: The student counselor is to evaluate the supervision received. Circle the number that
best represents how you, the student counselor, feel about the supervision received. After the
form is completed, the supervisor may suggest a meeting to discuss the supervision desired.

Name of practicum/Internship supervisor:
_________________________________________________

Period covered: from _______________________________ to _________________________

                                                                   Poor   Adequate        Good
1. Gives time and energy in observations, tape processing, and     1 2      3 4           5 6
   case conferences.

2. Accepts and respects me as a person.                            1 2       3 4          5 6
3. Recognizes and encourages further development of my             1 2       3 4          5 6
   strengths and capabilities.

4. Gives me useful feedback when 1 do something well.              1 2       3 4          5 6

5. Provides me the freedom to develop flexible and effective       1 2       3 4          5 6
   counseling styles.

6. Encourages and listens to my ideas and suggestions for          1 2       3 4          5 6
   developing my counseling skills.

7. Provides suggestions for developing my counseling skills.       1 2       3 4          5 6

8. Helps me understand the implications and dynamics of the        1 2       3 4          5 6
   counseling approaches I use.

9. Encourages me to use new and different techniques when          1 2       3 4          5 6
   appropriate.

10. Is spontaneous and flexible in the supervisory sessions.       1 2       3 4          5 6

11. Helps me define and achieve specific concrete goals for        1 2       3 4          5 6
    myself during the practicum experience.

12. Gives me useful feedback when I do something wrong.            1 2       3 4          5 6



                                                                           Revised August, 2008
                                                                    CC Site Supervisor Manual
                                                                                           31
13. Allows me to discuss problems I encounter in my practicum     1 2      3 4          5 6
    setting.

14. Pays appropriate amount of attention to both me and my        1 2     3 4          5 6
    clients.

15. Focuses on both verbal and nonverbal behavior in              1 2     3 4          5 6
    me and in my clients

16. Helps me define and maintain ethical behavior in counseling 1 2       3 4          5 6
    and case management.

17. Encourages me to engage in professional behavior.             1 2     3 4          5 6

18. Maintains confidentiality in material discussed               1 2     3 4          5 6
    in supervisory sessions.

19. Deals with both content and effect when supervising.          1 2     3 4          5 6

20. Focuses on the implications, consequences, and                1 2     3 4          5 6
    contingencies of
    specific behaviors in counseling and supervision.

21. Helps me organize relevant case data in planning              1 2     3 4          5 6
    goals and strategies with my client.

22. Helps me to formulate a theoretically sound rationale         1 2     3 4         5 6
of human behavior.

23. Offers resource information when I request or need it.        1 2     3 4          5 6

24. Helps me develop increased skill in critiquing and gaining    1 2     3 4          5 6
    insight from my counseling tapes.

25. Allows and encourages me to evaluate myself.                  1 2     3 4          5 6

26. Explains his/her criteria for evaluation clearly and in       1 2     3 4          5 6
   behavioral terms.

27. Applies his/her criteria fairly in evaluating my counseling   1 2     3 4          5 6
    performance.




                                                                         Revised August, 2008
                                                                           CC Site Supervisor Manual
                                                                                                 32
              ADDITIONAL COMMENTS AND/OR SUGGESTIONS
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________




Date                                            Signature of practicum student/intern

My signature indicates that I have read the above report and have discussed the content with my
supervisee. It does not necessarily indicate that I agree with the report in part or in whole.

Date                                            Signature of supervisor

Form 12.4, p. 2 of 2




                                                                                 Revised August, 2008
                                                                CC Site Supervisor Manual
                                                                                      33
                          ANALYSIS OF COUNSELING SESSION

Intern's Name: __________________________ Date of Interview ________________________
Client's Code Name: __________________________ Age ____________ Sex _____________
Number of interviews with client: ____________

Brief Summary of session content:




Intended goals:




Observations about client's behaviors/dynamics:




Comments on positive counseling behaviors/techniques:




Comment on areas of counseling practice that need improvement




Plans for further counseling:


                                                                    Revised August, 2008
                                                                         CC Site Supervisor Manual
                                                                                               34
                                CLIENT RELEASE FORM
                                   Georgia Southern University
                                   Counselor Education Program




I ___________________________________________________, agree to be counseled by an intern
student in the Counselor Education Program at Georgia Southern University.

I further, understand that I will participate in counseling interviews that will be audio-taped,
videotaped, and viewed by intern students.

I understand that I will be counseled by a graduate student who has completed advanced
coursework in counseling/therapy.

I understand that the intern will be supervised by a faculty member and/or a site supervisor.


Client's signature ______________________________________________________________



Age _____________________________ Date _______________________________________




Counselor's signature ___________________________________________________________




                                                                              Revised August, 2008
                                                               CC Site Supervisor Manual
                                                                                     35
                         PARENTAL RELEASE FORM
Parent's Name
_________________________________________________________________

Address
_____________________________________________________________________

Phone ______________________ (Home) ______________________ (Work)

The Graduate Department of Counselor Education at Georgia Southern University
conducts a Counseling Internship Course each semester at the university. The Internship
course is an advanced course in counseling required of all candidates in the Counseling
Program at Georgia Southern University. Students are required to audio-and/or videotape
counseling sessions as part of their course and degree requirements.

Intern's name ______________________________________________               would like to
work with your son/daughter, a student at
_____________________________________Community.

The counseling sessions conducted with your child will be audio-and/or videotaped and
will be reviewed by the intern's supervisor ____________________________. All
audio-and videotapes made will be erased at the completion of your child's involvement
in the program.

We hope that you will take the opportunity to have your child become involved in the
Counseling Program. If you are interested in having your child participate, please sign the
form where indicated.

Thank you for your cooperation.



                     Parent's Signature
               ___________________________________________


                     Date
               __________________________________________________




                                                                    Revised August, 2008
                                                                   CC Site Supervisor Manual
                                                                                         36

We appreciate your willingness to give your professional time and expertise during this process.
If you need further information or have concerns or recommendations please contact; Dr Leon E.
Spencer, Coordinator Community Counseling Program at (912) 681-5917 or
lespence@georgiasouthern.edu

Name ____________________________________ Site _______________________________

Dates of Placement _________________________ Director ___________________________
Site Evaluation Form
Site Supervisor ________________________________________________________________

Rate the following questions about your site and experiences with the following scale:

A- Very Satisfactory B- Moderately satisfactory C- Moderately unsatisfactory D- Very
Unsatisfactory
                                                Directions: Student completes this
1. ____ Amount of on-site supervision           form at the end of the Internship. This
2. ____ Quality and usefulness of on-site supervision          should be turned into
3. ____ Usefulness and helpfulness of faculty supervisor          the university
4. ____ Usefulness and helpfulness of group supervision           supervisor.
5. ____ Relevance of experience to career goals
6. ____ Exposure to and communication of school goals
7. ____ Exposure to and communication of school procedures
8. ____ Exposure to professional roles and functions within the school
9. ____ Rate all applicable experiences that you had at your site

                ____    Intake interviewing
                ____    Administration and interpretation of tests
                ____    Individual Counseling
                ____    Group Counseling
                ____    Consultation
                ____    Career Counseling
                ____    Collaboration with faculty and administration
                ____    Other

10. ____      Overall Evaluation of the site
11. ____      Overall Evaluation of on-site supervisor

Comments: Include any suggestions for improvements
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________




                                                                         Revised August, 2008
                                                          CC Site Supervisor Manual
                                                                                       37

INTERN EVALUATION OF SUPERVISOR*

Suggested Use: The internship supervisor can obtain feedback on the supervision by
asking counselors-in-training to complete this form. The evaluation could be done at
midterm and/or final. The purposes are twofold: (1) to provide feedback for improving
supervision and (2) to encourage communication between the supervisor and the
counselor-in-training.

Directions: The counselor-in-training is to evaluate the supervision received. Circle the
number that best represents how you, the counselor-in-training, feels about the supervision
received. After the form is completed, the supervisor may suggest a meeting to discuss the
supervision desired.

Name of Practicum/Internship supervisor: ___________________________________

Period covered: from _________________________ to _________________________

                                                                  Poor      Adequate        Good
1. Gives time and energy in observations, tape processing, and     12        3 4            5 6
   case conferences.
2. Accepts and respects me as a person.                             1 2      3 4            5 6
3. Recognizes and encourages further development of my              1 2      3 4            5 6
   strengths and capabilities.
4. Gives me useful feedback when 1 do something well.                1 2     3 4            5 6
5. Provides me the freedom to develop flexible and effective         1 2     3 4            5 6
   counseling styles.
6. Encourages and listens to my ideas and suggestions for            1 2     3 4            5 6
   developing my counseling skills.
7. Provides suggestions for developing my counseling skills.         1 2     3 4            5 6
8. Helps me understand the implications and dynamics of the          1 2     3 4            5 6
   counseling approaches I use.
9. Encourages me to use new and different techniques when            12      3 4            5 6
   appropriate.
10. Is spontaneous and flexible in the supervisory sessions.         1 2     3 4            5 6
11. Helps me define and achieve specific concrete goals for          1 2     3 4            5 6
   myself during the practicum experience.
12. Gives me useful feedback when I do something wrong.              1 2     3 4            5 6
13. Allows me to discuss problems I encounter in my practicum         1 2    3 4            5 6
   setting.


                                                                   Revised August, 2008
                                                              CC Site Supervisor Manual
                                                                                          38

14. Pays appropriate amount of attention to both me and my clients. 1 2         3 4    5 6

15. Focuses on both verbal and nonverbal behavior in me and.             1 2    3 4    5 6
    in my clients
16. Helps me define and maintain ethical behavior in counseling          1 2    3 4    5 6
    and case management.
17. Encourages me to engage in professional behavior.                    1 2    3 4    5 6
18. Maintains confidentiality in material discussed in supervisory       1 2    3 4    5 6
    sessions.
19. Deals with both content and effect when supervising.                 1 2    3 4    5 6
20. Focuses on the implications, consequences, and contingencies of 1 2         3 4     5 6
    specific behaviors in counseling and
supervision.
21. Helps me organize relevant case data in planning goals and      1 2          3 4    5 6
    strategies with my client.
22. Helps me to formulate a theoretically sound rationale of             1 2    3 4     5 6
    human behavior.
23. Offers resource information when I request or need it.               1 2    3 4    5 6
24. Helps me develop increased skill in critiquing and gaining           1 2    3 4    5 6
    insight from my counseling tapes.
25. Allows and encourages me to evaluate myself.                         1 2    3 4     5 6
26. Explains his/her criteria for evaluation clearly and in              1 2    3 4    5 6
   behavioral terms.
27. Applies his/her criteria fairly in evaluating my counseling          1 2    3 4     5 6
    performance.



                     ADDITIONAL COMMENTS AND/OR SUGGESTIONS


_________             _______________________________________________
Date                 Signature of intern

My signature indicates that I have read the above report and have discussed the content
with my supervisee. It does not necessarily indicate that I agree with the report in part or
in whole.
________            _______________________________________________
Date                Signature of supervisor




                                                                      Revised August, 2008
                                        CC Site Supervisor Manual
                                                                    39
2) Group Dynamics
3) Addiction Counseling
4) Theories of Counseling
5) Family Counseling
6) Models/Techniques of Counseling
7) Counseling Assessment, Diagnosis &
   Intervention
8) Practicum in Counseling
9) Career Counseling
10) Counseling Internship
11) Cross Cultural Counseling
12) Counseling Internship
13) Life Span Development
14) Learning Theories & Applications
15) Individual Analysis
16) Educational Research




                                                Revised August, 2008
CC Site Supervisor Manual
                               40




        Revised August, 2008

				
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