Counseling and Student Affairs
Department
Clinical Experience
Handbook
Professional School Counseling
INFORMATION AND PROCEDURES FOR
PRACTICUM AND INTERNSHIP
2013-2014
Professional School Counseling Program
Counseling and Student Affairs Department
Kutztown University of Pennsylvania
Kutztown, PA 19530
(610) 873-4204
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1
Dear Site Supervisors, Interns and Practicum students,
This Manual was designed to provide you with information about the practicum and
internship process. As you read the Manual, you will see that some of the information will
be more relevant to Site Supervisors while other information will be of particular interest
to the Practicum students or Interns. However, it is important for both of you to have the
same information in order to open the lines of communication.
I look forward to working with you throughout the academic year. Please feel free to
contact me at anytime. My email address is: hamlet@kutztown.edu
Thank you.
Helen S. Hamlet, Ph.D.
School Counseling Program Coordinator
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PRACTICUM
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3
Practicum
1. Prerequisites
All Core I courses must be completed prior to Practicum.
2. Procedure to enroll in Practicum:
Attend the Mandatory Practicum Meeting.
The Intent to Enroll form must be completed and submitted to the department immediately
following the mandatory practicum meeting. This meeting takes place in the Spring semester, one
yearprior to the Spring of your practicum semester.
The Site Agreement must be submitted to your Advisor by the third Monday in October along
with all clearances and proof of liability insurance. If this agreement and all forms are not
submitted by the third Monday in October, students will not be guaranteed a seat in the Practicum
class for the Spring semester. Students may have to wait until the following Spring semester.
3. Site Selection
Practicum sites are generally located by the student after careful consideration of his/her
professional goals and the type of field experience designated by the degree program. Students are
advised to begin seeking a practicum site early in the fall semester of the academic year prior to
beginning a spring practicum. The degree program coordinator and faculty can serve as resources
for locating internship sites.
4. Supervisor Qualifications
The site supervisors for students enrolled in all of the Counseling programs must have the
following qualifications:
1. A minimum of a Master’s degree in counseling with school counseling certification.
2. A minimum of five years of professionalschool counseling experience.
3. Knowledge of the program’s expectations, requirements, and evaluation procedures for
students.
4. Relevant training in counseling supervision.
Orientation, assistance, consultation, and professional development opportunities are provided by
counseling program faculty to site supervisors.
The onsite supervisors for practicum must sign a contract agreement with KU to confirm the field
placement. Contract is on pages 9-12 of this handbook.
5. Counseling Practicum Requirements
Students must complete supervised practicum experiences that total a minimum of 100 clock
hours over an academic term. Each student’s practicum includes all of the following:
1. At least 40 clock hours of direct service with actual clients that contributes to the
development of counseling skills.
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2. Weekly interaction that averages one hour per week of individual and/or triadic supervision
throughout the practicum by a site supervisor who is working in consultation with a program
faculty member.
3. An average of 1 1/2 hours per week of group supervision that is provided on a regular schedule
throughout the practicum by a program faculty member.
4. The development of program-appropriate audio/video recordings for use in supervision or live
supervision of the student’s interactions with clients.
5. Evaluation of the student’s counseling performance throughout the practicum, including
documentation of a formal evaluation within the final three weeks of the practicum.
Clearances and Liability Insurance
Clearances
All students completing ANY field experience in any school building in the state of Pennsylvania need
the following clearances.
[Note: You may need to copy and paste the links below into your browser]
1. PA Child Abuse Clearance:
http://www.dpw.state.pa.us/findaform/childabusehistoryclearanceforms/index.htm
All students must have a Child Abuse Clearance issued by the state when entering any school building
in the state of Pennsylvania. This clearance is valid for one year from date issued. This clearance
must be updated each year. It takes approximately 3 weeks to receive this clearance back from the
state.
2. Criminal Clearance: (www.psp.state.pa.us/portal/server.pt) All students must have a Criminal
Clearance issued by the state when entering any school building in the state of Pennsylvania. This
clearance is valid for one year from date issued. This clearance must be updated each year.
3.
4. Fingerprinting: All students must be fingerprinted before participating in ANY field experience.
Students must register and pay online through the PA COGENT SYSTEMS website
http://www.pa.cogentid.com
Liability Insurance
It is mandatory that all students carry professional liability insurance and maintain membership in a
professional organization throughout the program.
American Counseling Association (ACA) The ACA Student membership now includes liability insurance
to ACA student members enrolled and engaged in a master's degree counseling curriculum at a post
secondary institution. Coverage is solely while performing counseling services (e.g. practicum and
internship) related to such curriculum. http://www.counseling.org/
American School Counselor Association (ASCA) Promotes professional school counseling; encourages
interest in activities that affect personal, educational and career development of students and works with
parents, educators, and community members to provide a positive learning environment.
http://www.schoolcounselor.org/
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Copies of the clearances and proof of insurance must be submitted to the Practicum course
instructor prior to registering for classes.
Professionalism
The Department of Counseling and Student Affairs expects and requires all students to conduct themselves in
a professional manner. Professionalism is demonstrated through the department’s requirements identified in
the Student Academic Performance Evaluation Rubric (SAPER). The identified areas are: Openness to new
ideas and feedback; cooperation with others; self/other awareness; acceptance of responsibility; expression of
feelings and thoughts; attention to ethical, legal, and academic standards; initiation and motivation;
respectfulness; and cultural sensitivity. Specifically, professionalism in a practicum site would include: being
conscientious in performing tasks; being on time to the site and to meetings; communicating effectively with
your supervisor; utilizing ethical standards; and following through on communications.
Ethics and Professional Standards
The Department of Counseling and Student Affairs expects and requires all students to conduct themselves in
accordance with ASCA and ACA’s ethical standards. One specific areato be aware of during a practicum
experience is obtaining appropriate Informed Consent and Authorization for Audio/Video Recording.
Important Information regarding Practicum Requirements
Log Sheets: Please submit to your Practicum instructor on the first class of each month, starting in
February. Hours are kept track ofby the student via the Time Log sheet (this form available for download
from the Practicum courses’ D2L sites). Students are responsible for making and keeping copies of the
attached log sheet. Fill in the hours that you have completed every week for each month and at the end of
every month have your on-site supervisor (s) check and sign the log sheet. Please calculate your direct
service and total service hours each month. Log Sheet is available in this manual – page 13.
Direct Service Hour Requirements:
100 hours = 40 direct service hours
Schedule Considerations
•
Students begin their internship in the Spring semester starting in January. All practicum hours must
be complete by Finals Week of the Spring Semester.
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•
Even if students complete the required direct/total service hours before the end of the spring semester,
they are to continue at their placements through the final week, unless an agreement to prematurely
terminate from their respective practicum has been arranged with site-supervisors.
•
If your required hours are not completely accrued by the end of spring semester, contact your faculty
supervisor immediately. Students must be registered in a Practicum course to accrue hours and
meet the University requirements for liability coverage.
•
Students earn hours for work performed at the site or that is related to their Practicum responsibilities.
A student may not count time in terms of transportation to get to the site or work that is done outside
the practicum site.
•
Each site has its own calendar and holidays. Be aware of these holidays as you calculate the hours
you need to complete your practicum requirements. Students are expected to make arrangements with
their supervisor to review all practicum responsibilities and follow the placement’s holiday calendar
and/or make up missed hours.
•
If you have an emergency or are sick (and miss days at your practicum), you are to contact your site
supervisor prior to the absence.
Help with Trouble-shooting at Placements
Listed below is the chain of responsibility for any difficulty/concerns regarding a student's practicum site.
1. The student is to first speak with his/her on-site supervisor regarding any concerns s/he may have with
the placement. If the student does not feel s/he can speak with the on-site supervisor or needs
advice/support for how to do so, s/he is to speak with the instructor of the Practicum course. The
Practicum instructor will encourage the student to speak directly to her/his on-site supervisor.
2. If the concerns are not resolved, the instructor may make contact with the on-site supervisor to assist in
this process.
3. The Site supervisor may contact the Practicum course instructor at any time throughout the practicum.
Assessment of Practicum Skill Development
The practicum course is designed to assist students in the development of advanced counseling knowledge
and skills as part of their clinical internship experience. The classes will be held weekly throughout the
spring semester, unless otherwise noted on the course syllabus or announced by the course instructor.
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Grading, Participation and Attendance in Course
Enrolled students will be required to attend all classes on time throughout the spring semester. Active
participation in classes from all students will be a vital part of the course. It will be important that each
student comes to classes prepared with material from their practicum site and actively participates in case
updates, discussions, activities, and assignments. Evaluations from site supervisors will be gathered, and
will be incorporated into the student’s grade for the practicum course. Please refer to the syllabus for full
details on grading.
Site Supervisors’ Evaluation of Practicum Student’s Skill Development
Supervision and the assessment of a practicum student’s progress occur weekly. If a concern were to
arise regarding a practicum student’s progress, the site supervisor is strongly encouraged to contact
the practicum course instructor. Halfway through the practicum, the course instructor will contact
the site supervisor for feedback. This contact may take place through email or phone calls. In the last
two weeks of the practicum course, the course instructor will contact the Site Supervisor through an
email asking them to click on the link to the evaluation form (see Appendix section). The Site
Supervisor will then complete the form, print it, and then hit submit. The Site Supervisor will then
meet with their practicum student and review the completed evaluation form while providing
constructive feedback. The email sent to the Site Supervisors provides information about due dates.
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KUTZTOWN UNIVERSITY DEPARTMENT OF COUNSELING AND STUDENT
AFFAIRS
SCHOOL COUNSELING PRACTICUM SITE AGREEMENT
* Students will complete this form and the on-site supervisor will sign indicating that she/he agrees to the
practicum requirements.
Student Information:
Name: _____________________________________________________________________________
Home Address: ______________________________________________________________________
Home Phone: ____________________________ Cell Phone: _______________________________
KU Student ID #: _____________________ KU E-mail Address: ____________________________
Semester:
Fall
Spring
Year: ____________________
Program Track:
______ Elementary Certification
______ Secondary Certification
______ Elementary Certification/ Licensure
______ Secondary Certification/Licensure
__________________Dual Certification
__________________Dual Certification/Licensure
Practicum Site Information:
School Name: _____________________________________________________________
Phone Number: __________________________________________ Ext.: ____________
Address: _________________________________________________________________
_________________________________________________________________
Student Intern Days On-Site:_________________________________________________
On-Site Supervisor Information: ______________________________________________
(Print Name)
E-mail address: ______________________________________________
Degree & field of study: _______________________________________
Years of experience: __________________________________________
Please review all practicum requirements and sign on page three of this document. All pages of the site agreement
should be turned in to your Kutztown University Academic Advisor by the third Monday in October.
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KUTZTOWN UNIVERSITY DEPARTMENT OF COUNSELING AND STUDENT
AFFAIRS
SCHOOL COUNSELING PRACTICUM SITE AGREEMENT
The School Counseling Practicum offered by the Department of Counseling and Human Services at Kutztown
University is designed to provide the student counselor-in-training with: (1) an opportunity to gain practical onthe-job guidance and counseling experience in the public schools, and (2) a means of integrating didactic
experiences and information with actual experience under the supervision of a currently practicing PA certified
school counselor with five (5) years of experience.
I. The On-Site Supervisor shall be responsible to:
•
•
•
•
•
Assist with the development of the goals and objectives for the practicum field experience.
Provide the student with the opportunity to complete all requirements as listed in course syllabus, which
might include at least the following:
1. Conduct distinct classroom guidance lessons for students;
2. Provide the practicum student with appropriate student clients for individual counseling,
3. Provide the practicum student with an opportunity to lead at least 1 small counseling group
4. Conference and consult with parents and other school personnel;
5. Attend appropriate student support meetings, such as Student Assistance Programming (SAP),
Instructional Support Team (IST), RtII, and multi-disciplinary meetings;
6. Attend faculty meetings and in-services;
7. Coordinate career development activities;
8. And conduct other school counseling and guidance related duties.
Must provide the opportunity for the practicum student to audio/video tape individual, group, or classroom
sessions.
Provide the University Supervisor, on a form to be provided, an evaluation of the practicum student’s
performance and potential.
Provide the practicum student with a minimum of one (1) hour per week of direct, face-to-face, individual
or triadic supervision.
II. The University/faculty supervisor shall be responsible to:
•
•
•
•
Assist the student in designing the goals and objectives of the practicum field experience.
Provide ongoing group supervision during weekly seminar class
Solicit evaluative input from the on-site Supervisor and assume primary responsibility for assigning a
grade.
Provide leadership in assisting the practicum student in designing guidance project(s) as per class syllabus.
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KUTZTOWN UNIVERSITY DEPARTMENT OF COUNSELING AND STUDENT
AFFAIRS
SCHOOL COUNSELING PRACTICUM SITE AGREEMENT
III. The School Counseling Practicum Student shall be responsible to:
•
Provide proof of valid Acts 34, 151 and FBI (114) clearances, proof of counseling liability insurance, and
recent TB Test.
• Review site agreement form and hour requirements.
• Complete 100 hours per 3 credits, and 40 hours of the 100 hours must be in direct service (individual &
group counseling, individual/small group/classroom guidance, consultation).
• Maintain an accurate, written daily log of activities and experiences and secure supervisor’s signature on a
weekly basis.
1. Complete other guidance duties as assigned by the On-Site supervisor.
2. Fulfill all course requirements as assigned by the practicum professor.
3. Perform all duties and activities in accordance with FERPA, ASCA Ethical Standards, School District,
Kutztown University policies, and PA Law.
IV. Problems and Termination of Agreement
•
•
The term of this Agreement shall be 1 academic semester.
If problems/concerns arise with the Practicum Student or terms of the site agreement, the faculty or on-site
supervisor may make modifications or terminate the agreement ONLY in consultation with all parties
involved. Follow these steps for modification or termination of agreement.
1.
2.
3.
4.
5.
•
•
Contact the University Supervisor or Site Supervisor within 48 hours to discuss termination.
Notify the practicum student within 48 hours of the concern.
Submit a written report of concerns to all parties involved.
Make a decision for modification or termination of agreement in consultation with all parties.
If applicable, issue an amendment to the agreement.
In consultation, any party may terminate this Agreement.
The parties agree to continue their respective policies of nondiscrimination based on Title VI of the Civil
Rights Act of 1964 in regard to sex, age, race, color, creed, national origin, Title IX of the Educational
Amendments of 1972 and other applicable laws, as well as the provisions of the Americans with
Disabilities Act.
The undersigned agree to all the provisions stated in the Practicum Site Agreement (students are only responsible
for obtaining the On-site supervisor’s signature and providing their own):
Practicum Student___________________________________________ Date____________________
On-Site Supervisor__________________________________________ Date____________________
University Supervisor_______________________________________
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Date_____________________
11
PRACTICUM LOG
PLEASE ACCESS THIS FORM ON THE D2L SITE.
Counselor in Training's Name:______________________________________________
Week
Date
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Time at
Site
Daily
Direct
Hours
Total
Direct
Hours
Daily OnSite Hours
Total OnSite Hours
On-Site Supervisor's
Signature
12
Evaluation of Practicum Student: ________________________________________
Use the following scale to evaluate the trainee in each n the following areas. Circle the number that best
describes the characteristics. If student has not had opportunity to demonstrate this skill or knowledge,
please note that in the Comments section.
1=unsatisfactory
2= competent
3= above average
Characteristic:
1 2 3
Comments:
1. Attendance: Keeps and attends on time to
schedule & appointments
2. Dress: Dresses appropriately for the work
setting
3. Organization: Organizes & completes work
on time
4. Rules: Understands & is able to follow
school rules & procedures
5. Ethics: Follows ASCA ethical standards
6. Consultation: Works effectively with:
parents
teachers
administrators
7. Rapport: Establishes rapport with students
8. Basic skills: demonstrates basic skills in
empathy, listening & reflection
9. Effective counseling: Designs & implements
developmentally appropriate & effective
strategies
10. Focus: maintains appropriate focus &
pacing
11. Cultural sensitivity: Understands students’
worldview
12. Verbal skills: Makes clear statements &
questions that facilitate discussion
13. Follow-through: Maintains an on-going
counseling relationship
14. Progress: Effectively evaluates student
progress
15. Lesson planning: Plans developmentally
appropriate lessons
16. Management: Uses appropriate classroom
management strategies
If you have any additional comments please add them on the back of this page.
________________________________
Supervisor’s Signature
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______________
Date
13
INTERNSHIP
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Internship Completion Options
1. School Certification Options
a. Elementary school only (300 hours per 3 credits (600 hours for 6 credits); the equivalent of
two (2) full days per week
b. Secondary school only (300 hours per 3 credits (600 hours for 6 credits); the equivalent of two
(2) full days per week.
c. Dual certification – (300 hours per 3 credits – 6 credits required for Dual Certification); the
equivalent of one full day a week at each site
Even though the internship requirement is for six (6) credits, students are permitted to register for
only three (3) credits of internship per semester.
2. Site Selection
The Internship sites are generally located by the student after careful consideration of his/her
professional goals and the type of field experience designated by the degree program. Students are
advised to begin seeking an internship site in the spring semester of the academic year prior to
beginning internship. The degree program coordinator and faculty can serve as resources for
locating internship sites.
3. Supervisor Qualifications
The site supervisors for students enrolled in all of the Counseling programs must have the
following qualifications:
1. A minimum of a Master’s degree in counseling with school counseling certification.
2. A minimum of five years of professional school counseling experience.
3. Knowledge of the program’s expectations, requirements, and evaluation procedures for
students.
4. Relevant training in counseling supervision.
Orientation, assistance, consultation, and professional development opportunities are provided by
counseling program faculty to site supervisors.
The onsite supervisors for internship must sign a contract agreement with KU to confirm the field
placement. This agreement is on pages 20-23 of this Handbook. The signed contract is due the
second Monday in April.
Clearances and Liability Insurance
Clearances
As of April 1, 2007, all students completing ANY field experience in any school building in the state of
Pennsylvania need the following clearances.
PA Clearances Needed
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15
1. PA Child Abuse Clearance:
http://www.dpw.state.pa.us/findaform/childabusehistoryclearanceforms/index.htm
All students must have a Child Abuse Clearance issued by the state when entering any school
building in the state of Pennsylvania. This clearance is valid for one year from date issued. This
clearance must be updated each year. It takes approximately 3 weeks to receive this clearance
from the state.
2. Criminal Clearance: (www.psp.state.pa.us/portal/server.pt) All students must have a Criminal
Clearance issued by the state when entering any school building in the state of Pennsylvania. This
clearance is valid for one year from date issued. This clearance must be updated each year.
3. Fingerprinting: All students must be fingerprinted before participating in ANY field
experience. Students must register and pay online through the PA COGENT SYSTEMS website
http://www.pa.cogentid.com
Liability Insurance
It is mandatory that all students carry professional liability insurance and maintain membership in a
professional organization throughout the program.
American Counseling Association (ACA) The ACA Student membership now includes liability insurance
to ACA student members enrolled and engaged in a master's degree counseling curriculum at a post
secondary institution. Coverage is solely while performing counseling services (e.g. practicum and
internship) related to such curriculum. http://www.counseling.org/
American School Counselor Association (ASCA) Promotes professional school counseling; encourages
interest in activities that affect personal, educational and career development of students and works with
parents, educators, and community members to provide a positive learning environment.
http://www.schoolcounselor.org/
Copies of the clearances and proof of insurance must be submitted to the Internship course
instructor prior to registering for classes.
Professionalism
The Department of Counseling and Student Affairs expects and requires all students to conduct themselves in
a professional manner. Professionalism is demonstrated through the department’s requirements identified in
the Student Academic Performance Evaluation Rubric (SAPER). The identified areas are: Openness to new
ideas and feedback; cooperation with others; self/other awareness; acceptance of responsibility; expression of
feelings and thoughts; attention to ethical, legal, and academic standards; initiation and motivation;
respectfulness; and cultural sensitivity. Specifically, professionalism in a practicum site would include: being
conscientious in performing tasks; being on time to the site and to meetings; communicating effectively with
your supervisor; utilizing ethical standards; and following through on communications.
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Ethics and Professional Standards
The Department of Counseling and Student Affairs expects and requires all students to conduct themselves in
accordance with ASCA and ACA’s ethical standards. One specific areas to be aware of during an internship
experience is obtaining appropriate Informed Consent and Authorization for Audio/Video Recording.
Important Information regarding Internship Requirements
Log Sheets: Please submit to your Internship instructor on the first class of each month, starting in
October. Hours are kept track ofby the student via the Time Log sheet (this form available for download from
the Internship courses’ D2L sites). Students are responsible for making and keeping copies of the attached
log sheet for both semesters. Fill in the hours that you have completed every week for each month and at the
end of every month have your on-site supervisor (s) check and sign the log sheet. Please calculate your direct
service and total service hours each month. A copy of this log sheet is on page 23 of this Handbook.
Direct Service Hour Requirements:
300 hours=120 direct service hours
Schedule Considerations
•
Students begin their internship in the Fallsemester starting in late August. All internship hours must
be complete by Finals Week of the Spring Semester.
•
Even if students complete the required direct/total service hours before the end of the spring semester,
they are asked to continue at their placements through the final week, unless an agreement to
prematurely terminate from their respective internship has been arranged with site-supervisors.
•
If your required hours are not completely accrued by the end of spring semester, contact your faculty
supervisor immediately. Students must be registered in an Internship course to accrue hours and
meet the University requirements for liability coverage.
•
Students earn hours for work performed at the site or that is related to their Internship responsibilities.
A student may not count time in terms of transportation to get to the site or work that is done outside
the internship site.
•
Each site has its own calendar and holidays. Be aware of these holidays as you calculate the hours
you need to complete your internship requirements. Students are expected to make arrangements with
their supervisor to review all internship responsibilities and follow the placement’s holiday calendar
and/or make up missed hours.
•
If you have an emergency or are sick (and miss days at your internship), you are to contact your site
supervisor prior to the absence
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17
Help with Trouble-shooting at Placements
Listed below is the chain of responsibility for any difficulty/concerns regarding a student's internship.
•
The student is to first speak with his/her on-site supervisor regarding any concerns s/he may have
with the placement. If the student does not feel s/he can speak with the on-site supervisor or needs
advice/support for how to do so, s/he is to speak with theinstructor of the Internship course. The
Internship instructor will encourage the student to speak directly to her/his on-site supervisor.
4. If the concerns are not resolved, the instructor may make contact with the on-site supervisor to assist
in this process.
5. The Site supervisor may contact the Internship course instructor at any time throughout the
internship.
Assessment of InternshipSkill Development
The internship course is designed to assist students in the development of advanced counseling knowledge
and skills as part of their clinical internship experience. The classes will be held weekly throughout the fall
and spring semesters, unless otherwise noted on the course syllabi or announced by the course instructor.
Grading, Participation and Attendance in Course
Enrolled students will be required to attend all classes on time throughout the fall and spring semester.
Active participation in classes from all students will be a vital part of the course. It will be important that
each student comes to classes prepared with material from their internship site and actively participates in
case updates, discussions, activities, and assignments. Evaluations from site supervisors will be gathered
three times per year, and will be incorporated into the student’s grade for the internship course. Please
refer to the syllabi for full details on grading.
Site Supervisors’ Evaluation of Intern’s Skill Development
Supervision and the assessment of an intern’s progress occur weekly. If a concern were to arise regarding an
intern’s progress, the site supervisor is strongly encouraged to contact the internship course instructor. In
addition, a formal developmental assessment of skills is done three times during the 2-semester internship.
The Internship course instructor contacts the Site Supervisor through an email asking them to click on the
link to the evaluation form. The Site Supervisor will then complete the form, print it, and then hit submit.
The Site Supervisor will then meet with their intern and review the completed evaluation form while
providing constructive feedback. The evaluations take place in Fall, Winter and Spring. The email sent to
the Site Supervisors provides information about due dates.
The three evaluation forms (CIDACS) can be found on pages 23-25 of this Handbook. Having the forms
ahead of time provides the Site Supervisor with a copy to review and think about prior to electronically
submitting their completed form. In addition, making the forms available provides interns with information
on what specific skills will be assessed.
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KUTZTOWN UNIVERSITY DEPARTMENT OF COUNSELING AND STUDENT
AFFAIRS
INTERNSHIP SITE AGREEMENT
* Students will complete this form and the on-site supervisor will sign indicating that she/he agrees to the
internship requirements.
Student Information:
Name: _____________________________________________________________________________
Home Address: ______________________________________________________________________
Home Phone: ____________________________ Cell Phone: _______________________________
Ku Student ID # _____________________ KU E-mail Address: ______________________________
Semester:
Fall
Spring
Year: ____________________
Program Track:
______ Elementary Certification
______ Secondary Certification
______ Elementary Certification/Licensure
______ Secondary Certification/Licensure
Internship Site Information:
School Name: _____________________________________________________________
Phone Number: __________________________________________ Ext.: ____________
Address: _________________________________________________________________
_________________________________________________________________
Student Intern Days On-Site:_________________________________________________
On-Site Supervisor Information: ______________________________________________
(Print Name)
E-mail address: ______________________________________________
Degree & field of study: _______________________________________
Years of experience: __________________________________________
Please review all internship requirements and sign on page three of this document. All pages of the site agreement
should be turned in to your Kutztown University Academic Advisor by the second Monday in April.
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19
KUTZTOWN UNIVERSITY DEPARTMENT OF COUNSELING AND STUDENT
AFFAIRS
SCHOOL COUNSELING INTERNSHIP SITE AGREEMENT
The School Counseling Internship offered by the Department of Counseling and Human Services at Kutztown
University is designed to provide the student counselor-in-training with: (1) an opportunity to gain practical onthe-job guidance and counseling experience in the public schools, and (2) a means of integrating didactic
experiences and information with actual experience under the supervision of a currently practicing PA certified
school counselor with five (5) years of experience.
I. The On-Site Supervisor shall be responsible to:
•
•
•
•
•
•
•
Assist with the development of the goals and objectives for the internship field experience.
Provide the student with the opportunity to complete all requirements as listed in course syllabus, which
might include at least the following:
1. Conduct distinct classroom guidance lessons for students;
2. Provide the intern with appropriate student clients for individual counseling, with a minimum of
four (4) separate student clients;
3. Provide the internship student with an opportunity to lead at least 1 small counseling group per 3
credits each semester;
4. Conference and consult with parents and other school personnel;
5. Attend appropriate student support meetings, such as Student Assistance Programming (SAP),
Instructional Support Team (IST), RTI, and multi-disciplinary meetings;
6. Attend faculty meetings and in-services;
7. Coordinate career development activities;
8. Conduct a guidance project, such as coordinating a career day or leading a parent workshop, with
the joint approval of on-site and university supervisor as per syllabus;
9. And conduct other school counseling related duties.
Must provide the opportunity for the Intern to audio/video tape individual, group, or classroom sessions.
Provide the University Supervisor, on a form to be provided, an evaluation of the student intern's
performance and potential.
Provide the intern with a minimum of one (1) hour per week of direct, face-to-face, individual or triadic
supervision.
If requested by school or university representative, meet with the faculty supervisor
If the approval of the school board or administration is required, the on-site supervisor shall inform the
intern of the procedure to obtain such approval.
II. The University/faculty supervisor shall be responsible to:
•
•
•
•
•
Assist the student in designing the goals and objectives of the internship field experience.
Provide frequent communication with site supervisor.
Provide ongoing group supervision during weekly seminar class and/or at a time to be determined at the
discretion of the instructor.
Solicit evaluative input from the on-site Supervisor and assume primary responsibility for assigning a
grade.
Provide leadership in assisting the student in designing guidance project(s) as per syllabus.
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KUTZTOWN UNIVERSITY DEPARTMENT OF COUNSELING AND STUDENT
AFFAIRS
SCHOOL COUNSELING INTERNSHIP SITE AGREEMENT
III. The School Counseling Intern shall be responsible to:
•
Provide proof of valid Acts 34, 151 and FBI (114) clearances, proof of counseling liability insurance, and
recent TB Test.
• Review site agreement form and hour requirements, the equivalent of two (2) full days per week, with site
supervisor.
• Complete 300 hours per 3 credits (600 hours for 6 credits), and 120 hours of the hours per 3 credits (240
hours for 6 credits) must be in direct service (individual & group counseling, individual/small
group/classroom guidance, consultation).
• Maintain an accurate, written daily log of activities and experiences and secure supervisor’s signature on a
weekly basis.
0. Complete other guidance duties as assigned by the On-Site supervisor.
1. Fulfill all course requirements as assigned by the internship professor.
2. Perform all duties and activities in accordance with FERPA, ASCA Ethical Standards, School District,
Kutztown University policies, and PA Law.
IV. Problems and Termination of Agreement
•
•
The term of this Agreement shall be 1 academic year.
If problems/concerns arise with the Student Intern or terms of the site agreement, the faculty or on-site
supervisor may make modifications or terminate the agreement ONLY in consultation with all parties
involved. Follow these steps for modification or termination of agreement.
1.
2.
3.
4.
5.
•
•
Contact the University Supervisor or Site Supervisor within 48 hours to discuss termination.
Notify intern within 48 hours of the concern.
Submit a written report of concerns to all parties involved.
Make a decision for modification or termination of agreement in consultation with all parties.
If applicable, issue an amendment to the agreement.
In consultation, any party may terminate this Agreement.
The parties agree to continue their respective policies of nondiscrimination based on Title VI of the Civil
Rights Act of 1964 in regard to sex, age, race, color, creed, national origin, Title IX of the Educational
Amendments of 1972 and other applicable laws, as well as the provisions of the Americans with
Disabilities Act.
The undersigned agree to all the provisions stated in the Internship Site Agreement (students are only responsible
for obtaining the On-site supervisor’s signature and providing their own):
Student Intern______________________________________________ Date____________________
On-Site Supervisor__________________________________________ Date____________________
University Supervisor_______________________________________
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Date_____________________
21
INTERNSHIP LOG
PLEASE ACCESS THIS FORM ON THE D2L SITE.
Counselor in Training's Name:______________________________________________
Week
Date
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Time at
Site
Daily
Direct
Hours
Total
Direct
Hours
Daily OnSite Hours
Total OnSite Hours
On-Site Supervisor's
Signature
22
Evaluation #1
Counseling Internship Developmental Assessment of Counseling Skills
Professional School Counselor
School Counselor-in-Training Name __________________________________ Date: __________
Evaluator Name: __________________________________ Position: _____________________
Directions:
For each of the performance areas, please use the following rating scale:
0 - Unsatisfactory
1 - Needs Improvement
2 - Proficient
3 - Above Average
Also, include any relevant comments addressing the intern’s professional skill development.
Description
Rating
Professional Behaviors
Adheres to agreed upon schedule.
0 1
2
3
Arrives on time for internship.
0 1
2
3
Dresses appropriately for internship.
0 1
2
3
Demonstrates appropriate interpersonal relationships with colleagues and staff.
0 1
2
3
Meets and effectively communicates with primary site supervisor (and secondary supervisors, if applicable),
demonstrating an openness and willingness to learn.
0 1
2
3
Demonstrates flexibility or adaptability.
0 1
2
3
Takes initiative in seeking out additional advice, resources or supervision, when needed.
0 1
2
3
Effectively establishes rapport with students.
0 1
2
3
Communicates to student the nature and boundaries of the counseling relationship.
0 1
2
3
Demonstrates effective listening skills.
0 1
2
3
Accurately reflects student’s thoughts and feelings.
0 1
2
3
Demonstrates an awareness and sensitivity to student’s developmental stage and developmental context.
0 1
2
3
Demonstrates an awareness and sensitivity to student’s cultural and contextual/systemic reality.
0 1
2
3
Identifies and assesses factors that are supporting or impeding student’s academic, career, personal success.
0 1
2
3
Identifies student’s strengths and needs with contextual, cultural and developmental awareness.
0 1
2
3
Demonstrates knowledge of school procedures and policies.
0 1
2
3
Effectively identifies school resources and uses appropriately.
0 1
2
3
Plans with knowledge and understanding of the school district's calendar.
0 1
2
3
Identifies community resources that can be used to improve student achievement and success.
0 1
2
3
Comments:
Counseling Skill Development
Comments:
Management System/Accountability
Comments:
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23
Evaluation #2
Counseling Internship Developmental Assessment of Counseling Skills
Professional School Counselor
School Counselor-in-Training Name __________________________________ Date: __________
Evaluator Name: __________________________________ Position: _____________________
Directions:
For each of the performance areas, please use the following rating scale:
0 - Unsatisfactory
1 - Needs Improvement
2 - Proficient
3 - Above Average
Also, include any relevant comments addressing the intern’s professional skill development.
Description
Rating
Professional Behaviors
Able to make effective use of constructive feedback.
0
1
2
3
Accepts personal and professional responsibility and initiates action to resolve concerns.
0
1
2
3
Accurately self appraises counseling skills and performance.
0
1
2
3
Works with his/her supervisor in monitoring student's progress.
0
1
2
3
Consistently adheres to the ASCA ethics code.
0
1
2
3
Demonstrates ability to maintain confidentiality with students, teachers and colleagues.
0
1
2
3
Exercises patience with students while balancing and attending to the multiple tasks required of a school counselor.
0
1
2
3
Promotes equity and access for every student.
0
1
2
3
Demonstrates willingness to try new or different strategies with students.
0
1
2
3
Counsels individual students and small groups of students with identified needs and concerns.
0
1
2
3
Demonstrates effective listening skills.
0
1
2
3
Accurately reflects student's thoughts and feelings.
0
1
2
3
Consults effectively with parents or guardians, teachers, administrators and other relevant individuals to improve student
success.
0
1
2
3
Collaborates with parents or guardians, teachers and administrators to help students establish post-secondary goals and
develop and use planning skills; implements strategies and actions as appropriate.
0
1
2
3
Actively participates in school meetings (e.g., IEP, SAP, parent)
0
1
2
3
Conducts competent crisis assessment and intervention, including suicide risk management.
0
1
2
3
Implements an effective referral process with administrators, teachers, other school personnel and community resources.
0
1
2
3
Comments:
Counseling Skill Development
Develops materials and instructional strategies based on relevant research.
0
1
2
3
Teaches school/classroom guidance units effectively and uses differentiated instruction strategies.
0
1
2
3
Tracks time spent providing direct and indirect service to students.
0
1
2
3
Completes paperwork as required by the site and/or school district.
0
1
2
3
Advocates with supervisor(s) for the role of the school counselor in the school and the guidance program in the school
and within the broader context of the school district.
0
1
2
3
Collects and utilizes data to improve program development and student planning.
0
1
2
3
Develops measurable outcomes for school counseling programs, activities, interventions, and experiences.
0
1
2
3
Comments:
Management System/Accountability
Comments:
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24
Evaluation #3
Counseling Internship Developmental Assessment of Counseling Skills
Professional School Counselor
School Counselor-in-Training Name __________________________________ Date: __________
Evaluator Name: __________________________________ Position: _____________________
Directions:
For each of the performance areas, please use the following rating scale:
0 - Unsatisfactory
1 - Needs Improvement
2 - Proficient
3 - Above Average
Also, include any relevant comments addressing the intern’s professional skill development.
Description
Rating
Professional Behaviors
Takes a leadership role within the counseling department.
0 1
2
3
Demonstrates self-confidence in the role of counselor.
0 1
2
3
Encourages staff involvement to ensure the implementation of the school guidance program.
0 1
2
3
Becomes an integral member of the school community.
0 1
2
3
Promotes equity and access for every student.
0 1
2
3
Consistently adheres to the ASCA ethics code.
0 1
2
3
Selects appropriate assessment strategies to evaluate student's academic, career, and personal/social
development and interprets assessment information in a valid and relevant manner.
0 1
2
3
Facilitates appropriate closure to counseling relationships.
0 1
2
3
Provides support for students who are transitioning to other sites, schools, etc.
0 1
2
3
Demonstrates sensitivity and comfort interacting with socioculturally diverse students and colleagues.
0 1
2
3
Effectively communicates the needs of the students for the upcoming school year.
0 1
2
3
Participates in designing, implementing, and evaluating prevention and intervention programs to meet the
needs of the school (e.g. School-wide Positive Behavior Support (SPBS), workshops, parent education,
programs using peer helping strategies, teacher training).
0 1
2
3
Consults with teachers, staff and community organizations to promote student success.
0 1
2
3
Implements student programs (e.g., peer helping, conflict resolution, time management, self-esteem).
0 1
2
3
Advocates for learning and academic experiences and opportunities to promote student development.
0 1
2
3
Advocates for school policies, programs, and services that enhance a positive, equitable and responsive
school climate.
0 1
2
3
Uses data to improve program development and student planning.
0 1
2
3
Discusses the counseling department services management system and the program action plans with
her/his supervisor and, if possible, the school administrator.
0 1
2
3
Comments:
Counseling Skill Development
Comments:
Management System/Accountability
Comments:
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