Texas A & M-Commerce
Department of Counseling
Coun 660 Advanced Internship Proposal
(This is a fillable form. Use the Tab key to move from field to field)
Date:
Semester for Proposal:
Name:
Phone:
Email:
Address:
Advanced Internship Site:
Name of Agency:
Phone:
Address:
Host Supervisor:
Credentials of Supervisor:
On this form, concisely outline the proposed internship experience. Include the following
information in your outline:
1. Goals for your professional development during the internship
2. General activities which will help achieve those goals
3. Approximate number of hours each week to be devoted to:
a. Direct client contact (describe clients & types of interventions)
b. Supervision (identify supervisors, schedule for contact with each, & proposed
supervision format)
c. Indirect client services (describe types of activities)
4. Signatures identified on page 2. The signed internship proposal must be submitted to
the Internship Coordinator before the end of the first week of classes. Enrollment in
COUN 660 may be dropped for a student if the Internship Proposal is not on file with
the Internship Coordinator by the deadline.
(Reminder: The guide for clock hours is approximately 300 (Fall/Spring) and 250
(Summer) with 50% of those in direct client contact, and 50% in supervision and
indirect client services.)
(If you are doing two different placements (e.g. advanced practicum and a supervision
experience, or teaching) submit two separate proposals.)
1. GOALS:
 Demonstrate advanced counseling skills in group and individual counseling
sessions.
 Employ effective brief counseling techniques appropriate for school settings.
 Receive and utilize constructive feedback from my supervisors and
colleagues.
 Objectively evaluate my progress.
2. SPECIFIC ACTIVITIES WITH HOURS
 Individual counseling
 Group counseling
 Review/watch counseling tapes, books, or articles
 Supervision sessions
 Peer consultation
 Classroom guidance
Total
10-12 hours per week.
4 hours per week.
3 hours per week.
1 hour per week.
1 hour per week.
6 to 8 hours per week.
25 to 29 hours per week
3. SIGNATURES
Intern __________________________________________ Date: ______________
Host supervisor __________________________________
Date: ______________
TAMU-C Faculty Supervisor _________________________ Date: _____________
Internship Coordinator ______________________________ Date: ______________
Texas A&M University-Commerce Department of Counseling
Return this form with signatures to Dr. Chris Simpson.
Departmental fax number: 903-886-5780