Name:__________________
Graduate Program Degree or Certification Plan (check one)
 Counseling Psychology: 48-hour program (LPC)
 Clinical Mental Health Counseling: 60-hour program (LPC)
 Marriage and Family Therapy: 48-hour program (LMFT)
 Marriage and Family Therapy: 60-hour program (LMFT)
 Counseling (School Counselor)
 Specialist in School Psychology (LSSP)
 Licensed Psychological Associate (LPA)
Semester and Course Requested for Field Placement:
 Fall
Practicum I
 Spring
Year: ________
Practicum II
 Summer
Practicum III
Practicum IV
Internship I
Internship II
SELF-INVENTORY FOR PRACTICUM/INTERNSHIP SELECTION
Directions: Prior to enrolling in practicum or internship students are asked to complete this selfinventory.
1.
My long term career goal is:
2.
My area of special interest is:
3.
The type of client who I would most like to work with is:
4.
The type of client who I would least like to work with is:
5.
I feel most qualified/skilled to work with:
6.
I feel least qualified/skilled to work with:
7.
An area of competence I would like to enhance or develop is:
8.
My ideal site supervisor would have the following characteristics:
9.
I feel most comfortable in a working environment with the following characteristics:
10.
I have had the following professional or volunteer experience and/or course work related to
counseling:
11.
My personal areas of strength and weakness which should be considered in the site selection
process include:
Strengths:
Areas for improvement:
12.
My ideal counseling internship would be a(n) ____________________________________
agency performing ________________________________ duties with
_______________________________ (type of population).
To get help from Dr. Fiala in finding an appropriate site, complete this form and email it to
sam.fiala@ct.tamus.edu.