3.1b School Counseling Practicum Contract
Pittsburg State University
Department of Psychology and Counseling
Practicum in Counseling Agreement
This agreement among:
1) Department of Psychology and Counseling
Pittsburg State University
Pittsburg, KS 66762
(620) 235-4569
2) School
Name:
Address:
Phone:
3) Student
Name:
Address:
Phone:
Is for the purpose of providing Practicum in Counseling for the above-named student for:
Course Number
Credits
Semester
It is mutually agreed:
That the above-named school or agency will provide the following services and supervision:
1) The assignment of a practicum site supervisor who has at least a master’s degree in
counseling and experience in the agency or school, or their equivalent.
2) An orientation to the school or agency and specific student counselor duties defined.
3) Coordination of the student counselor’s duties (a minimum of 50 clock hours for every
credit hour) with the activities of school or agency
4) Clients with whom the student counselor may conduct audiotape-recorded, confidential
counseling interviews for analysis and supervision.
5) Site supervision of the student counselor’s work with feedback and support.
6) Feedback concerning the student’s progress to the university supervisor.
3.1b School Counseling Practicum Contract
That the student counselor in practicum will:
1) Be at the agreed upon location at the scheduled times.
2) Demonstrate professional behavior consistent with ethical guidelines.
3) Protect the anonymity of all clients during the campus supervision process.
4) Be assigned the following specific duties and responsibilities (if applicable):
5) Attend regular PSU classes to receive instruction regarding counseling performance
(practicum students only).
6) Keep a log of the time spent in the practicum which records dates, hours, and the
duties performed.
7) Write an evaluation of their experience in the field to be submitted to the faculty
supervisor at the end of the semester.
That the PSU Counseling Practicum Faculty will provide the following:
1) Advise the student of the requirements (classes, activities, reports, evaluations)
involved in the practicum course.
2) Provide coordinating classes to discuss common needs and experiences and assist
student counselor (practicum only).
3) Maintain periodic contact with the site supervisor and the student counselor to discuss
the student counselor’s progress.
4) Give the student counselor feedback regarding the faculty’s supervision and maintain
appropriate records for registration and grading (practicum only).
5) Monitor audiotaped and/or videotaped samples of counseling interviews (practicum only).
6) Provide systematic supervision of the counseling sessions conducted by the student
counselor (practicum only).
7) Be responsible for the evaluation and grading of the student counselor (with site
supervisor in practicum).
It is the expectation of all three parties involved that the above conditions be met. Should
they not be met, it is imperative that all three parties discuss the situation at the earliest
possible date.
The following signatures verify agreement to these conditions:
Student
Date:
Site Supervisor
Date:
(Printed Name)
(Signature)
Site Authorizing Officer
(Building Principal)
(Printed Name)
(if different from supervisor)
(Signature)
PSU Practicum Instructor
Date:
Date: