Department of Counseling, Administration, Supervision & Adult Learning
College of Education
Practicum (CNS 680) Checklist
____ Application
____ Orientation Meeting
____ Site Placement information sheet (first day of class)
____ Liability insurance verification (first day of class)
____ Practicum learning contract - signed by site supervisor and student (first day of class)
____
Hour Logs
____ Required recordings
1. ________
2. ________
3. ________
4. ________
5. ________
6. ________
____ Evaluations
____
____
____
Assessment of Student by Site Supervisor
Student Assessment of Site Supervisor
Assessment of Site
____ Class Requirements
CMHC students only - in addition to the above forms:
Turn in to the C, SW and MFT Board
____ Training Supervision Agreement sent to C, SW and MFT Board Part A: by supervisee, Part B by site supervisor
____ Practicum Report to C, SW and MFT Board within 30 days of practicum completion
Checklist/rev. 2011