School and Clinical Child Psychology program
SCHOOL PLACEMENT CONFIRMATION FORM
Director of Clinical Training: Mary Caravias, Ph.D., C. Psych. (Tel: 416-978-0624, Fax: 416-926-4763)
To the student: Complete this form in consultation with your placement supervisor and return to the
Director of Clinical Training before starting your placement.
_____________________________________________________________________________
Student Name: ______________________________________________
Telephone number(s):__________________________________________
Practicum Guidelines
Practicum Duration: Practica must include a minimum of 250 hours in a school setting. Typically
students are in placement one day each week from mid September through to June. Exceptions need
to be discussed with the Clinical Director.
Supervision: The practicum supervisor must be a registered psychologist or psych. associate.
It is expected that students receive a minimum of one hour of face-to-face supervision for each day that
they spend in their placement. A formal evaluation of the student’s progress is completed twice during
the year. Students also provide the Clinical Director with a confidential evaluation of their supervisors.
Activities: Prior to undertaking the school practicum, SCCP students have taken courses in
psychological assessment, ethical and professional issues and learning disabilities. They have learned
test and measurement theory, and how to administer and score a basic battery of cognitive and academic
measures. They have also assessed one school-age client under close supervision. Their experience is
very limited, however, in terms of the range of client needs, tests they know, and the various roles of the
school psychologist/psychological associate.
In their practicum, SCCP students require opportunities to complete assessments under supervision.
(Often initial assessments are completed jointly and as the student gains confidence in his or her skills
and the supervisor gains confidence in the student, the student is given more autonomy.) Students
benefit from exposure to interview opportunities (interviewing parents prior to the assessment and
providing face-to-face feedback afterwards). They also benefit from exposure to a range of
psychometric tests and from opportunities to observe in the classroom. Finally, students benefit from the
opportunity to learn about the role of school psychologists through exposure to school team and IPRC
meetings, to board-specific policies as they relate to identification, placement, informed consent and to
consideration of potential ethical dilemmas. Although, it is not a requirement of the school practicum
experience, the opportunity to be involved in intervention opportunities taking place within the school
provides an added benefit to the student.
Practicum Hours
Proposed start date: ___________________
Proposed end date: ___________________
Number of hours per week: _____________
Total number of hours: ________________
Practicum Duties and Responsibilities
Opportunities for Direct Clinical Service (e.g., How many assessments and consultations is
the student likely to complete? What opportunities will there be for interviewing; for observation
in the classroom; and for working with students from a diversity of backgrounds, for exposure to
a range of presenting problems, for exposure to a range of psychometric tests?)
Supervision (Please specify the frequency and duration of supervision with the primary
supervisor and with any others involved in the student’s training.)
Other Opportunities for Professional Training (e.g., Will the student have opportunities to
attend school team meeting and IPRCs? Opportunities for intervention experience?
Opportunities to attend professional development events? Any other opportunities?)
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Updated May 2014
Supervisor Information
* Supervisor Name: ________________________________________________________
* Highest degree earned:
M.A. 
M.Ed. 
Ed.D. 
Ph.D. 
Psy.D. 
* Granted at: (Name of University) _____________________________________________
* Current job title:___________________________________________________________
* This information is listed with the SCCP program faculty in the OISE/UT Bulletin under the heading: Adjunct Clinical
Supervisors, in the year following the year of supervision.
Are you a registered psychologist? Yes  or a registered psychological associate? Yes 
Phone number: ________________________ Email: ___________________________
Institutional Name: _______________________________________________________
Full Institutional
Mailing Address: ________________________________________________________
________________________________________________________
Honorarium payment procedures:
 Please donate my honorarium to the SCCP program.
 Please pay the honorarium directly to me, the supervisor.
The honorarium payment is made by July. If the honorarium is to be paid to you, you will be contacted
for DOB and SIN information. Please provide a mailing address:
__________________________________________________________________________
Note to the supervisor: We are required to collect CV information from you to conform to CPA
accreditation requirements. You will be contacted separately regarding this.
Signatures: Please sign below to confirm that the above information is accurate. In addition, both
the SCCP student and supervisor acknowledge that Dr. Caravias will be contacting supervisors
periodically to discuss the SCCP student’s progress and to offer recommendations in order to
further develop the student’s clinical needs.
Date:
Student’s Signature
Date:
Supervisor’s Signature
Copies of this Form
Supervisors and students are encouraged to keep copies of this completed form. This original signed
form should be given to: Dr. Mary Caravias, Director of Clinical Training, SCCP program.
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Updated May 2014