Department of Counseling, Administration, Supervision & Adult Learning
College of Education
SCHOOL COUNSELING INTERNSHIP LEARNING CONTRACT
Intern’s Name
CSU ID #
Intern’s Address
Zip
Intern’s Phone Number
Cell
Intern’s Email
Supervisor’s Name
Supervisor’s Title
License
Supervisor’s Phone
Phone #2
Supervisor’s Email
Placement Name
Placement Address
Zip
INTERNSHIP SITE/SUPERVISOR AGREEMENT:
I. The internship site is a Primary or Secondary School in which school counseling
services are provided.
II. Students will be afforded a 32 week internship during the academic year (August May).
III. Interns will be afforded a minimum of 600 internship hours. At least 40% of the
hours will be in direct service (providing assistance to student(s) in the form of
individual counseling, group counseling, family counseling, guidance, or psychoeducational initiatives aimed at remediating difficulties or facilitating personal
growth).
School Counselor Internship Contract/rev. 2015
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IV. The remaining internship hours will consist of individual supervision (on site),
group instruction (CSU), providing clinical hours in the Counseling and
Academic Success Clinic (CASC) under the direction of the faculty in the
Counseling program at CSU, consultation with teachers, parents, school
psychologists and staff, treatment plans, completion of paperwork,
staff/educational programming (e.g. in-service programs, conferences etc.).
Research, clerical, and administrative functions do not qualify as internship hours.
V. One hour of individual supervision (on site) will be provided the intern per week.
This supervision will be provided by a Certified or Licensed School Counselor in,
at least, their third year in the position of School Counselor.
VI. The internship site will authorize the audio and/or video taping of most individual
counseling sessions. The tapes are used to evaluate the intern and to help him/her
develop counseling skills. Tapes will be reviewed by the CSU faculty and may
also be viewed during group instruction. The identities of the students will at no
time be compromised and all recordings will be erased after supervisory review.
Clients and/or their parents will be asked to sign a release authorizing the intern to
tape their sessions. If the site does not have a release form for such taping, a
sample form will be provided by the Counselor Education program at Cleveland
State University.
VII. The on-site supervisor agrees to meet with the CSU faculty and intern during each
semester of the internship. In addition, the supervisor will complete the required
following documentation:
Documentation of Hours
Intern Evaluations
For Site Supervisor Only:
Please list any relevant training and/or continuing education* you have received in the past
two years regarding counselor supervision:
* If you haven’t receive any training specific to counselor supervision in the past two years,
you can register for a free continuing education workshop for Counselor Supervision
through the Continuing Education Program at Cleveland State University. For further
information, please contact the Continuing Education Coordinator, Noelle Muscatello, at
216-687-3867 or cecasal@csuohio.edu. You can also visit the website at:
http://www.campusce.net/csucasal/category/category.aspx?C=&S=47
School Counselor Internship Contract/rev. 2015
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I agree that the Internship will meet or exceed the identified requirements. I understand
that these requirements meet the guidelines as mandated by the State of Ohio
Department of Education and the guidelines of the Council on Accreditation of
Counseling and Related Educational Programs as adopted by the Counselor Education
program at Cleveland State University. In addition, I will assist the School Counselor
Intern in securing competence in the provision of counseling services as outlined by
the Intern Agreement in this Learning Contract.
Supervisor’s Signature
School Counselor Internship Contract/rev. 2015
Date
3
INTERN AGREEMENT:
I. Orientation toward and the competent administration of Intake Interviews, as
consistent with the Internship site protocol, including Mental Status Examination,
structured or semi-structured interview, or other assessment measures and forms.
II. Orientation toward and adequate preparation of treatment plans as dictated by the
administrative procedures of the site and the population served.
III. Orientation to and demonstration of competence in the ASCA National Model
service delivery systems components.
IV. Orientation to and demonstration of competence in school setting appropriate
treatment of developmental or mental health disorders in a diverse group of
clients.
V. Demonstration of cultural awareness, adaptation to, and sensitivity toward diverse
client populations (e.g. racial or ethnic minorities, women, elderly persons,
physically/intellectually challenged, gay men/lesbians/bisexuals, economically
marginalized individuals, etc.).
VI. Cogent and accurate record keeping in accord with the ethical guidelines of the
American School Counseling Association, legal requirements of the State of
Ohio, and the mandates of the internship site.
VII. Demonstration of appropriate interpersonal skills during counseling sessions and
in contact with supervisors, staff, and other professional contacts directly
associated with the counseling internship.
I agree to secure competence in the provision of counseling services, as defined in the
Intern Agreement portion of this Learning Contract. In addition, I will collaborate
with the Internship Supervisor in meeting the requirements as set forth by the
Internship Site/Supervisor portion of this Learning Contract.
Intern’s Signature
School Counselor Internship Contract/rev. 2015
Date
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