School Psychology: Internship
A Manual for Interns, Supervisors, and Hiring Agencies
SCHOOL OF EDUCATION
UNIVERSITY OF WISCONSIN-STOUT
2013-2014
TABLE OF CONTENTS
Preface.................................................................................................................................................... 3
A. Internship Prerequisite ....................................................................................................................... 4
B. Internship Course Objectives .............................................................................................................. 4
C. Skill and Knowledge Competencies ................................................................................................... 4
D. Human Diversity and Underserved Populations ................................................................................. 5
E. Internship Placement .......................................................................................................................... 5
F. Supervision ......................................................................................................................................... 6
G. Documentation Requirements ............................................................................................................ 7
H. Course Requirements ......................................................................................................................... 8
I. Evaluation ............................................................................................................................................ 9
Appendices
Appendix A: Intern Letter ...................................................................................................................... 13
Appendix B: Intern Data Sheet .............................................................................................................. 14
Appendix C: Internship Agreement Form .............................................................................................. 15
Appendix D: Field Supervisor/Mentor Letter.......................................................................................... 18
Appendix E: Site Internship Evaluation ................................................................................................. 19
Appendix F: University Supervisor Mid-Year/Formative Evaluation ...................................................... 26
Appendix G: Portfolio Review................................................................................................................ 28
Appendix H: Outcome-Based Artifact Project Description…………………………………………………..30
Appendix I: Outcome-Based Artifact Rubric…………………………………………………………….........31
Appendix J: Log .................................................................................................................................... 32
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PREFACE:
UW-STOUT SCHOOL PSYCHOLOGY PRACTICA AND INTERNSHIP SUMMARY
The University of Wisconsin-Stout (UW-Stout) School Psychology Program prepares practitioners in the field of
school psychology. Within the context of the scientist-practitioner model, program goals are designed to train highly
reflective professionals who provide effective school psychology services that result in direct, measurable, and
positive impact on children, families, and schools.
UW-Stout’s School Psychology Program requires five applied experiences: four practica and an internship.
Candidates apply their knowledge and skills in relevant settings, under conditions of appropriate supervision and
evaluation.
1) Field Practicum I in a school setting
2) Field Practicum II in a school setting
3) Clinical Practicum I at Stout Clinical Services Center
4) Clinical Practicum II at Stout Clinical Services Center
5) Internship in School Psychology
The practica and internship are similar in the following ways:
A. Each experience requires candidates to meet skill and knowledge competencies from the National
Association of School Psychologist’s (NASP’s) 10 domains of professional practice.
B. Each experience is consistent with the program goals (see School Psychology Student Handbook).
C. Each experience emphasizes and values human diversity.
Each practica and internship are distinct in the following ways:
A. Objectives
B. Placement procedures
C. Expectations of skill development and level of independence
D. Course requirements
E. Style/system of supervision
UW-Stout’s School Psychology Program assesses candidates’ professional competencies through a progressive
model of skill development. As candidates move through practica and internship, their knowledge and skills are
assessed by program faculty and qualified site supervisors along a continuum of performance-based stages.
Practicum I
Practicum II
Internship
Unestablished
Observer
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
The system and style of supervision appropriately matches candidates’ skill progression and performance. During
early applied experiences, as candidates develop skills at the observer and novice stages, supervision is tutorial in
nature. During later applied experiences, as candidates progress into practitioner stages, supervision becomes highly
consultative and the relationship between the supervisor and intern is that of a mentor and mentee.
UW-Stout’s School Psychology Program provides appropriate oversight to ensure placements provide a breadth of
quality activities, which are integrated across the NASP Practice Model domains. Collaboration between the
university and sites ensure candidates have diverse experiences, appropriate levels of supervision, and successfully
achieve the diverse goals of the school psychology program.
Each practicum and internship has its own manual, which provides the policies, procedures, and requirements of the
applied experience.
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A. Internship Prerequisites
Candidates are recommended to internship when they develop emerging practitioner competencies,
demonstrated through successful completion of the following:
1. All coursework
2. Two semesters of field practicum (SPSY 781/782)
3. Four credits of clinical practicum (SPSY 784/785)
4. Evaluations of his/her portfolio at benchmarks 2 and 3.
B. Internship Course Objectives
1. Interns will demonstrate established practitioner to advanced practitioner level school psychology
competencies, consistent with the NASP Practice Model, integrating the full range of domains of
practice: (See Skills and Knowledge Competencies below.)
2. Interns will reflect on, and accurately determine, which competency domains need skill
improvement, skill expansion, and/or skill maintenance.
3. Interns will reflect on and evaluate the importance of collaboration and consultation on their
personal practice and own personal health.
4. Interns will examine and critique their role in the school organization related to the NASP Practice
Model domains.
5. Interns will demonstrate leadership skills in investigations and program evaluations to improve
services for students.
6. Interns will demonstrate skills in evidenced-based, ethics-based, and problem-solving models.
7. Interns will reflect on and critically evaluate the emotions associated with being a first-year school
professional in positive, healthful ways.
C. Skill and Knowledge Competencies
The goal of the Internship in School Psychology is to become an established to advanced practitioner, who
is highly reflective and integrates and applies the full range of NASP domains:
1.
Data-Based Decision Making and Accountability: School psychologists have knowledge of and
skills in varied models and methods of assessment and data collection for identifying strengths and
needs, developing effective services and programs, and measuring progress and outcomes.
2.
Consultation and Collaboration: School psychologists have knowledge of and skills in varied
models and strategies of consultation, collaboration, and communication applicable to individuals,
families, groups, and systems and methods to promote effective implementation of services.
3.
Interventions and Instructional Support to Develop Academic Skills: School psychologists
have knowledge of biological, cultural, and social influences on academic skills; human learning,
cognitive, and developmental processes; and skills in developing and implementing evidencebased curricula and instructional strategies.
4.
Interventions and Mental Health Services to Develop Social and Life Skills: School
psychologists have knowledge of biological, cultural, developmental, and social influences on
behavior and mental health, behavioral and emotional impacts on learning and life skills, and skills
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in developing and implementing evidence-based strategies to promote social–emotional
functioning and mental health.
5.
School-Wide Practices to Promote Learning: School psychologists have knowledge of school
and systems structure, organization, and theory; general and special education; technology
resources; and skills in developing and implementing evidence-based school practices that
promote learning and mental health.
6.
Preventive and Responsive Services: School psychologists have knowledge of principles and
research related to resilience and risk factors in learning and mental health, skills in implementing
services in schools and communities to support multitiered prevention, and skills in implementing
evidence-based strategies for effective crisis response.
7.
Family–School Collaboration Services: School psychologists have knowledge of principles and
research related to family systems, strengths, needs, and culture; skills in implementing evidencebased strategies to support family influences on children’s learning and mental health; and
strategies to develop collaboration between families and schools.
8.
Diversity in Development and Learning: School psychologists have knowledge of individual
differences, abilities, disabilities, and other diverse student characteristics; principles and research
related to diversity factors for children, families, and schools, including factors related to culture,
context, and individual and role difference; and skills in implementing evidence-based strategies to
enhance services and address potential influences related to diversity.
9.
Research and Program Evaluation: School psychologists have knowledge of and skills in
research design, statistics, measurement, varied data collection and analysis techniques, and
program evaluation sufficient for understanding research and interpreting data in applied settings.
10.
Legal, Ethical, and Professional Practice: School psychologists have knowledge of the history
and foundations of school psychology; multiple service models and methods; ethical, legal, and
professional standards; and other factors related to professional identity and effective practice as
school psychologists.
D. Human Diversity and Underserved Populations
The School Psychology Program at the University of Wisconsin-Stout is fully committed to instilling the
value of multiculturalism and human diversity. The program encourages and guides students to
develop their knowledge and skills in best practices related to diverse and/or underserved populations,
including language, race, disability status, religion, cultural background, and sexual orientation. This is
accomplished by discussion of current research and practices related to diversity in areas such as
assessment, diagnosis, consultation, and intervention, and is infused throughout course content.
Additionally, relevant focused objectives are embedded into practicum and internship plans to allow
students to gain applied experiences working with diverse and underserved populations, appropriate to
their individual school settings.
E. Internship Placement
1. Hours and Timeline: UW-Stout’s Internship in School Psychology is the culminating applied
experience, completed on a full-time basis over one year or on a half-time basis over two consecutive
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years. A total of 1,200 internship hours are required, with a minimum of 600 internship hours completed
in a school setting.
2. Placement Process
 The school psychology intern is responsible securing an internship placement that meets the
criteria for the NASP and UW-Stout’s School Psychology Program by participating in the hiring
process for the organization to which he/she is applying.
 During the hiring process, school psychology interns are responsible for informing the hiring
agency of the internship requirements (Agreement Form, Appendix C).
 If the hiring agency has additional questions about requirements, the university supervisor will
provide information so both the intern and hiring agency feel comfortable with the arrangement.
 Because both UW-Stout’s School Psychology Program and the NASP require broad internship
experiences, when applying to internship sites, a student should only accept positions which
offer diverse responsibilities, a varied role, and a quality experience.
3. Site Characteristics and Hiring Agency's Responsibilities
 Consistent with the Agreement Form (see Appendix C), the hiring agency commits to providing
the interning school psychologist a role which is diverse. The school psychologist will need to
provide direct and indirect psychological services to children, youth, and/or families from
varying ethnicities, socioeconomic backgrounds, abilities, disabilities, characteristics, and/or
needs. The setting should provide the interning school psychologist opportunities to provide
assessment, intervention, consultation, and prevention services.
 The hiring agency will release the interning school psychologist for participation in two days,
one per semester, of professional development at UW-Stout.
 Other responsibilities related to contract, calendar, work environment, and release time can be
found on the Agreement Form (Appendix C).
4. University Responsibility
 UW-Stout School Psychology Program is responsible for providing direct oversight to the
internship experience to ensure appropriateness of placement.
 Open communication and collaboration between the university and sites ensure candidates
have diverse experiences, appropriate levels of supervision, and successfully achieve the
diverse goals of the school psychology program.
 The school psychology program will provide the following to the intern, field supervisor/mentor,
and employing agency: information on internship requirements, support for supervision, and
assistance with licensing.
 A university supervisor will monitor the progress of the interning school psychologist by the
following: direct contact with the field supervisor/mentor at least once per semester, weekly
contact with the intern via on-line discussion boards, meeting with the intern once per semester
during seminar, and evaluating the intern.
F. Supervision
1. Field Supervisor/Mentor
 The field supervisor/mentor must hold a full state school psychologist’s license (or other
appropriately credentialed psychologist in non-school settings), have three years of
experience, and have had at least one year of experience in the school district (or agency)
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




within which the school psychology intern will be working (refer to university supervisor for
alternatives if this last requirement is not feasible).
The field supervisor/mentor shall be responsible for no more than two interns at any given
time, unless the field supervisor/mentor has been assigned a significant portion of their time
devoted to supervising interns.
NASP standards and UW-Stout’s School Psychology program require a minimum of two hours
a week of supervision per full-time week on average. The preponderance of supervision is
provided on at least a weekly, individual, face-to-face basis. Supervision time may be adjusted
proportionately for less than a full-time week or schedule.
The field supervisor/mentor, with prompting from the intern, will complete two evaluations—one
towards the end of the first semester and one towards the end of the second (see Appendix E).
In the event that a concern of a serious nature arises, the field supervisor/mentor is directed to
contact the University supervisor, to discuss the matter in detail and formulate a plan. See
Evaluation section below for options of plan formulation.
For internship, the style of supervision shifts to mentorship. Supervisors/mentors offer support,
ask reflective questions, offer themselves as a source of knowledge, help interns process the
emotions of their first year as school psychologists, and evaluate the interns’ effectiveness and
mastery of skill.
2. University Supervisor
 The university supervisor is a program faculty or academic staff member teaching in the
School Psychology Program.
 The university supervisor will provide the following to the intern, field supervisor/mentor, and
employing agency: information on internship requirements, support for supervision, and
assistance with licensing (through the School of Education).
 University supervision is highly consultative. Supervision involves the weekly on-line
consultation discussion board and the monthly questions/assignments. Interns and the
university supervisor are in regular and frequent communication through on-line coursework.
 The university supervisor makes periodic, direct contact with the field supervisor/mentor, at
least once per semester. The goal is to keep communication-lines open, address issues if they
arise, check in on the intern’s progression of skill, and clarify expectations.
 The university supervisor assesses the intern’s progress through formative and summative
evaluation, using course requirements as artifacts (see below).
G. Documentation Requirements (refer to Learn@Stout for due dates)
The following documentation needs to be submitted to the university supervisor by the intern.
1. Data Sheet: A data sheet with relevant contact information regarding the practicum site must be
completed and turned into instructor at the beginning of the first seminar (see Appendix B).
2. School Psychology Internship Agreement Form: The agreement outlines the responsibilities of
the hiring organization, the intern, the field supervisor/mentor, and the university supervisor (see
Appendix C). If this form is not completed in a timely manner, the student will be dropped from
internship.
3. Professional Liability Insurance: Each intern, as a practicing professional in a school-based
setting, must submit documentation of professional liability coverage.
4. Internship Log: Interns must maintain a Log of Activities (see Appendix J). A Summary Log is
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turned into the university supervisor at the end of each term. Interns are expected to show a wide
variety of activities.
H. Course Requirements (refer to Learn@Stout for due dates)
1. Internship Seminars
 There is one seminar per semester for interns. Students are required to participate in two
seminars during the 1,200-hour internship.
 All interns are required to attend unless an intern’s placement is farther than one day’s
driving distance to UW-Stout. Students who do not attend are required to complete a
paper to cover the same learning objectives as seminar.
 Seminars take place for six to eight hours on a given date. For those completing the
Action Research project, the program will attempt to schedule the seminar on a day
adjacent to research preparation or presentation days.
2. On-Line Monthly Reflection Assignments
 UW-Stout’s School Psychology Program uses Learn@Stout, a web-based course
delivery system, for university supervision.
 Through this web-based program, students are required to complete and post monthly
reflection assignments related to the course objectives. The following are examples of
assignments.
Month 1 – Update your classmates on your current placement. What are you excited
about? What are you worried about? Who is helping you process the emotions of
starting this new job?
Month 2 – In your last semester of practicum, you developed goals for your internship
year. As you reflect on your current skill level, use the course objectives for this
internship to refine those goals.
Month 3 – Request a copy of your job description. Looking over the last three
months, compare your actual job duties to the job description. Reflect on the breadth
of your role and your role in the school system.
Month 4 – Before your field supervisor/mentor meets with you about your evaluation,
look over the evaluation yourself. Mark the domains in which you look for skill
improvement, skill expansion, or skill maintenance. Post a reflection.
Month 5 – Post a resource you have found very helpful this year. Why did you pick
this resource to share?
Month 6 – Given all you have learned this year, what are some ‘words of wisdom’ you
could share with the students moving into internship next year to help them survive the
year? What encouragement has your current field supervisor/mentor given you this
year?
Month 7 – Examining the goals you developed and refined in month 2, reflect on
whether you have met these goals.
Month 8 – Looking back on the year, reflect on the emotions you have experienced at
different times. Report on self-care strategies you have utilized and what you will take
away from the experience on the personal-social level.
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3. On-Line Consultation Discussion Board
 Through the Learn@Stout Consultation Discussion Board, interns are expected to have
weekly communication with each other and the university supervisor. They will use each
other as a resource as they problem-solve cases, processes, laws, and ethical issues.
 Students are expected to post and respond once per week. Discussion board activity
is closely monitored by the university supervisor. University supervisor will interact and
respond to on-line discussions; however, the primary focus of the discussion board is for
peer to peer interaction and consultation.
 Interns will uphold confidentiality on this discussion board by not disclosing identifying
information in the cases they are discussing. Interns are encouraged to contact the
university supervisor via phone if they need assistance on issues which are inappropriate
to post.
4. Outcome-Based Project
 Each semester interns will complete a project. They will present the projects during
seminars and submit artifacts that demonstrate direct, measurable, and positive
outcomes on children, families, and/or school. One project/artifact needs to be
behavioral in nature and the other academic in nature.
 Appendix H is a description of the project and artifact requirement. Please use this as a
guide for determining what kind of project to conduct.
 The artifacts from the project can be part of the interns’ portfolios, but will be evaluated in
more depth using a rubric (appendix I) by the university supervisor.
5. Portfolio Update
 As part of Benchmark 4, interns will update their portfolio and bring it to the last seminar.
 Interns will provide three artifacts for each of the domains. Most portfolio artifacts at this
juncture should reflect established to advanced practitioner levels.
I. Evaluation
1. Formative/Mid-Year Performance-Based Evaluation
 Field Supervisor/Mentor Evaluation: Towards the end of the intern’s first semester of
internship, the field supervisor/mentor fills out the Internship Evaluation (see Appendix
E). Because the purpose of this tool is to provide formative feedback to the interning
school psychologist, field supervisors/mentors should meet with the intern personally
about the intern’s performance. The interns are then responsible for sending these
evaluations to the university supervisor.
 University Supervisor Evaluation: At the end of the first semester, the University
Supervisor will complete a mid-year/formative evaluation to assess the course objectives
(see Appendix F). Interns will receive these evaluations as part of the submission of
their mid-term grade.
 Outcome-Based Project: As discussed above, each intern will complete an outcomebased project (see Appendix H) for evaluation by the university supervisor, which
displays a positive impact, at mid-year seminar. The university supervisor will evaluate
using Appendix I. Interns may also use the project as an artifact in their final portfolio.
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2. Summative/Final Performance-Based Evaluation
 Field Supervisor/Mentor Evaluation: Towards the end of the intern’s second semester,
the field supervisor/mentor again fills out the Internship Evaluation (see Appendix E).
While the intent of this rating is summative, field supervisors/mentors are still
encouraged to meet with the intern about his/her performance. The interns are then
responsible for sending these evaluations to the university supervisor.
 Portfolio Review: As part of Benchmark 4, all students will submit their final portfolio for
a summative review (see Appendix G) by the university supervisor.
 Outcome-Based Project Review: As discussed above, each intern will submit an
outcome-based project (see Appendix H) for evaluation by the university supervisor,
which displays a positive impact, at final seminar. The university supervisor will evaluate
using Appendix I. Interns may also use the project as an artifact in their final portfolio.
3. Serious Performance Issues
 The hiring agency has a right to expect quality services provided by the intern, within the
framework of appropriate supervision, mentoring and support. In the event that a
concern of a serious nature arises, the field supervisor/mentor is directed to contact the
University supervisor, to discuss the matter in detail and formulate a plan that may
include the following:
 A) a three-way meeting with intern to discuss the issue of concern and develop an
informal plan to address or remediate the issue, B) a three-way meeting with the intern
to discuss the issue of concerns and develop a formal remediation plan, C) termination
of the intern.
 While the hiring agency is highly encouraged to include the university on the discussion
and execution of such a measure, it has the right to remove an intern, as with any
employee, when cause or justification warrants it through their own system.
4. Minimum Performance Expectations
Successful completion of internship requires all of the following:
 80% of ratings at the Established Practitioner level, or higher, on the Summative/Final
Site Evaluation (appendix E)
 80% of ratings at the Established Practitioner level, or higher, on the Final Portfolio
Evaluation (appendix G)
 At least 1 Outcome-Based Artifact Review showing positive impact on students, families,
or schools (appendixes H and I)
5. Course Grade
Field Supervisor/Mentor and University Supervisor Evaluations
On-Line Monthly Assignments
On-Line Consultation Board
Benchmark 4 Portfolio Review
Completion of Documentation Requirements
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35%
25%
20%
10%
10%
Page 10
Appendices
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Appendix A: Intern Letter
Dear School Psychology Intern:
Welcome to your Internship! You have completed your coursework and practica work, and through those
experiences, you have developed foundational knowledge and skills. Through gaining employment as a
first-year school psychologist, you have now reached the culminating applied experience. The focus during
this year is on becoming a practitioner who is highly reflective and integrates and applies the full range of
the NASP (National Association of School Psychologists) domains.
This manual, along with the Internship D2L site, contains everything needed to navigate the internship
requirements. Completion of the requirements is critical to your ability to earn a state license and national
certification (NCSP). Please read through this manual, and if you haven’t logged onto D2L yet, please go
there now for specific instructions on paperwork and due dates.
As you start your internship, I want to provide you with some tips for how to handle this professional
experience in an intern role.
 Keep open communication with both the site mentor/supervisor and university supervisor. We are
here to support you. Right at the start of the year, set up regular visits with yours site mentor.
Some interns have found work lunches create a great time for supervision discussions.
 If you run into overly complicated, risky, or controversial cases or situations, please keep both your
site mentor/supervisor and university supervisor breached of the situation, along with your district
administrator.
 Many people find they experience a wide variety of emotions during their first job. While your
site/mentor is not your personal counselor, he/she certainly has transitioned from a training
program to the job field already. Your mentor might be a person to work through some of those
emotions.
 Stay involved in your professional organizations at both the state level and national level. The
organizations provide you support and valuable resources.
 Comply with the National Association of School Psychologist’s (NASP’s) Code of Conduct and
other relevant professional standards (e.g., APA, ACA).
 Comply with all of your district/institutional rules and regulations in a professional manner regarding
the following, but not limited to: confidentiality/privileged communication, school/office hours,
building codes, dress/grooming, and attendance/absence.
 Take full advantage of the D2L site for consultation and collaboration. Your colleagues will
become valuable assets.
 Stay on top of course requirements. Don’t let due dates creep up on you and your supervisor. If
you have forms that need to be completed by your supervisor, you are responsible for prompting
them and getting the forms turned in.
Please note that the program does have minimum performance expectations for completion of internship,
which can be found on page 10 of the manual. These expectations will be more important towards the end
of the year, but we do want to make you aware of them at this point.
Congratulations on reaching this step in your training. We will ‘see you’ on-line!
Sincerely,
Dr. Christine Peterson
UW-Stout’s School Psychology Internship Supervisor
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Appendix B
School Psychology Internship Data Sheet
University of Wisconsin-Stout
Intern:
(Last)
(First)
ID:
Home Address:
Home Phone:
Email:
Internship
Address:
Work Phone:
Field Supervisor:
Address:
Phone:
Email:
District Administrator:
Phone:
Email:
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Appendix C
SCHOOL PSYCHOLOGY INTERNSHIP AGREEMENT FORM
University of Wisconsin - Stout
Intern’s Name:
Student ID #:
Date:
School District or Agency:
Contractual Period:
1st Day of Employment:
The employing agency/internship site, the site supervisor/mentor, the first year interning school
psychologist, and the school psychology program at University of Wisconsin-Stout agree to the following
stipulations:
Hours, Setting, and Breadth of Role
The internship experience requires 1200 hours and can be completed on a full-time basis over a
period of one academic year or on a half-time basis over two consecutive academic years.
At least 600 clock hours of the internship shall occur in a school setting and shall provide a balanced
exposure to general and special education programs.
In the internship setting, the interning school psychologist should provide direct and indirect
psychological services to children, youth, and/or families from varying ethnicities, socioeconomic
backgrounds, abilities, disabilities, characteristics, and/or needs. The setting should provide the
interning school psychologist opportunities to provide assessment, intervention, consultation, and
prevention services.
Expectations of UW-Stout’s Training Program
1. The school psychology program will endorse the interning school psychologist after he/she has
completed all academic preparation necessary for initial/internship licensure by the state’s licensing
agency.
2. The internship is a for-credit experience that is recognized by academic credit from UW-Stout.
3. The school psychology program will provide the following to the intern, field supervisor/mentor, and
employing agency: information on internship requirements, support for supervision, and assistance
with licensing.
4. A university supervisor will monitor the progress of the interning school psychologist by the following:
direct contact with the field supervisor/mentor at least once per semester, weekly contact with the
intern via on-line discussion boards, meeting with the intern once per semester during seminar, and
evaluating the intern project and portfolio.
5. The university supervisor will establish and maintain open communication with employing the
agency/internship site.
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Expectations of the Site Supervisor/Mentor
1. The field supervisor/mentor must hold a full state school psychologist’s license (or other appropriately
credentialed psychologist in non-school settings), have three years of experience, and have had at
least one year of experience in the school district (or agency) within which the school psychology
intern will be working (refer to university supervisor for alternatives if this last requirement is not
feasible).
2. The field supervisor/mentor shall be responsible for no more than two interns at any given time,
unless the field supervisor/mentor has been assigned a significant portion of their time devoted to
supervising interns.
3. The field supervisor/mentor shall provide an average of at least two hours of supervision per full-time
week to the interning school psychologist.
4. The field supervisor/mentor will verify the interning school psychologist’s experiences on appropriate
paperwork.
5. The field supervisor/mentor will monitor the progress of the intern and evaluate his/her skills once per
semester using the Internship Evaluation Rubric.
6. If issues arise with the interning school psychologist, the site supervisor/mentor will contact the
university supervisor.
Expectations of the Employing Agency/Internship Site
The interning placement agency shall provide appropriate support for the internship experience which shall
include the following:
1. A written contractual agreement specifying the period of appointment and the terms of compensation;
2. A schedule of appointments consistent with that of district or agency school psychologists (e.g.,
calendar, participation in in-service meetings, etc.);
3. A provision for participation in continuing professional development activities, including one day of
seminar at UW-Stout per semester;
4. Reimbursement for expenses consistent with policies pertaining to district or agency school
psychologists;
5. An appropriate work environment including adequate supplies, materials, and office space;
6. Release time for the field supervisor/mentor to engage in supervisory activities;
7. A commitment to the internship as a diversified training experience.
Expectations of the First-Year Interning School Psychologist
1. The interning school psychologist is expected to comply with district/institutional rules and regulations
and the National Association of School Psychologist’s (NASP’s) Code of Conduct.
2. The interns will plan activities, discuss problems, and consult with their field supervisor/mentor on a
regular basis.
3. The intern will attend all scheduled seminars, participate weekly in an on-line discussion board with
the university supervisor, complete a final project, and complete a final review of his/her portfolio.
4. The intern will complete all documentation requirements in a timely fashion each semester.
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On the rare occasion where the site supervisor/mentor is employed in a different district than the interning
school psychologist, the intern, field supervisor/mentor, university supervisor, and employing agency of
both the intern and mentor will discuss a separate agreement.
PARTIES TO THE AGREEMENT
Intern:
Printed Name
Signature
Date
Signature
Date
Signature
Date
Signature
Date
School District Administrator:
Printed Name
Field Supervisor/Mentor:
Printed Name
University Supervisor:
Printed Name
After completed, the intern should upload to the D2L site.
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Appendix D: Field Supervisor/Mentor Letter
Dear School Psychology Internship Supervisor/Mentor:
Thank you for providing field supervision/mentorship to ____________, as he/she completes her School
Psychology Internship. We trust this experience will prove beneficial to both of you.
This letter is to inform you that I am Stout’s university supervisor. As a result, I will be calling you sometime
this semester to check how the experience if going for both of you. Typically, UW-Stout’s university
supervisors conduct supervision to the student through web-based contacts (Learn@Stout). Via this webbased program, interns do case-consultation with each other, report on activities, and reflect on their new
responsibilities. If this is not enough support for the intern, site visits can be arranged.
I am enclosing a University of Wisconsin-Stout School Psychology Internship Manual. While the manual is
a helpful reference, your intern is responsible for prompting you when they need paperwork completed by
you. At this point, you have already read and signed the Internship Agreement Form (Appendix C). If you
have questions about your responsibilities, this form is an easy reference.
In addition to the Agreement Form, below is a list of supervisory activities which are helpful to interns:
 Per NASP, field supervisors/mentors spend two hours on average per week assisting interns
with cases and questions and familiarizing them with staff, district policy, state laws, etc. Past
supervisors have reported that more time is often needed at the start of the year and less time at
the end. Mentors and interns often find it beneficial to schedule routine supervisory working
lunches, or something similar.
 Orient the intern with district or agency rules and regulations, and monitor compliance. Address
any issues with the intern.
 Make sure the intern has knowledge of, and access to, all necessary and available resources and
programs in the agency or district.
 If necessary, arrange for the intern to be introduced to, and included in, any institutional/agency
professional groups or organizations.
 Encourage the intern to stay active in local, state, and national school psychology associations.
 Monitor that the intern’s assigned responsibilities are appropriate in scope and number for the
intern’s skill development. If not, advocate for support.
 Engage the intern in open and honest discussion about their role. When necessary, help them
process typical “first-year” emotions.
 In the event that a concern of a serious nature arises, please contact the University supervisor to
discuss the matter in detail and formulate a plan.
Please note that the program does have minimum performance expectations for completion of internship,
which can be found on page 10 of the manual. These expectations will be more important towards the end
of the year, but we do want to make you aware of them at this point.
If you have any questions, comments, or concerns please do not hesitate to contact me. I can be reached
at < petersonchris@uwstout.edu>. Thanks, again, for your assistance. I look forward to talking with you
later on in the semester.
Sincerely,
Christine Peterson, Ph.D.
University of Wisconsin-Stout’s School Psychology Internship Supervisor
petersonchris@uwstout.edu
Internship in School Psychology Manual
Page 17
Appendix E: School Psychology Internship Evaluation
University of Wisconsin—Stout
Student Name: _________________________________________
Field Mentor Name: _________________________________
School Site: ____________________________________________
Review Date: ________________
Mid-Year/Formative
Final/Summative
Directions: Using the following performance-based stages as a guide, please rate the student on each item.
Novice
Advanced Novice
Emerging Practitioner
Established
Practitioner
Advanced Practitioner
Student demonstrates
the skills and behaviors
necessary to participate
in and contribute to
relevant activities and
functions; building
competence while
continuing to receive
substantial guidance
and supervision.
Student demonstrates
the skills and behaviors
necessary to
significantly participate
in and substantially
contribute to relevant
activities and functions;
continuing to build
competence while
requiring reduced
levels of direct
supervision. Continued
indirect supervision is
expected.
Student demonstrates
the skills and behaviors
necessary to work
independently;
expanding competence
and building fluency.
Continued indirect
supervision and regular
consultation is
expected.
Student demonstrates
the skills and behaviors
necessary to work
independently while
integrating and
applying the full range
of competencies.
Continued indirect
supervision and
occasional consultation
is expected.
Student demonstrates
the skills and behaviors
necessary to work
independently while
integrating and
applying the full range
of competencies.
Student shows a level
of knowledge, practice,
and leadership
consistent with a highly
reflective practitioner.
Occasional consultation
is expected.
Minimum Performance Expectation at Final/Summative Evaluation: In order for the candidate to complete internship, he or she
must have 80% of ratings in the established practitioner level or higher.
NASP Domain 1: Data-Based Decision
Making and Accountability
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
1. Utilizes varied methods of assessment
for identifying a comprehensive student
profile of strengths and weaknesses (i.e.,
cognitive, academic, social-emotional,
adaptive).
2. Identifies all aspects of the referral
concern to be addressed by the
assessment.
3. Accurately administers, scores, and
interprets norm-referenced and
curriculum-based measures.
4. Accurately conducts comprehensive
functional behavioral assessments which
lead to effective intervention plans.
5. Accurately collects and graphs data.
Internship in School Psychology Manual
Page 18
Not
Observed
6. Completes reports that are precise,
well-integrated, and understandable.
7. Uses data to measure outcomes of
services as part of a comprehensive
problem solving model.
NASP Domain 1 meets WI Department of Public Instruction Pupil Service Standards 3
NASP Domain 2: Consultation and
Collaboration
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
Not
Observed
Established
Practitioner
Advanced
Practitioner
Not
Observed
1. Applies psychological and educational
principles to achieve positive outcomes
for children (behavioral, problem-solving,
mental health, organizational,
instructional).
2. Effectively communicates and works
collaboratively within a group/meeting
setting (i.e., participates actively in
and/or effectively leads group meetings.)
3. Facilitates a problem-solving process
amongst parents and/or professionals for
planning, implementing, and evaluating
interventions.
NASP Domain 2 meets WI Department of Public Instruction Pupil Service Standard 5, 7
NASP Domain 3: Interventions and
Instructional Support to Develop
Academic Skills
Novice
Advanced
Novice
Emerging
Practitioner
1. Demonstrates knowledge of curriculum
and instructional strategies that facilitate
academic achievement (ex., teacherdirected instruction, literacy instruction,
peer-tutoring, interventions for selfregulation and planning/organization,
etc).
2. Develops appropriate academic goals
for children with diverse abilities,
disabilities, backgrounds, strengths, and
needs.
3. Develops and implements (directly or
via consultation) appropriate academic
interventions that are linked to student
needs.
Internship in School Psychology Manual
Page 19
4. Evaluates effectiveness of academic
interventions and makes appropriate
changes based on empirical evidence.
NASP Domain 3 meets WI Department of Public Instruction Pupil Service Standards 2, 6
NASP Domain 4: Interventions and
Mental Health Services to Develop Social
& Life Skills
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
Not
Observed
Established
Practitioner
Advanced
Practitioner
Not
Observed
1. Demonstrates knowledge of strategies
in social-emotional, behavioral, and
mental health services (ex., counseling,
behavioral intervention, social skills
interventions, instruction for selfmonitoring, etc).
2. Develops appropriate social-emotional
and adaptive goals for children with
diverse abilities, disabilities, backgrounds,
strengths and needs.
3. Develops and implements (directly or
via consultation) appropriate
social/emotional/behavioral
interventions that are linked to student
needs.
4. Evaluates effectiveness of
social/emotional/behavioral
interventions and makes appropriate
changes based on empirical evidence.
NASP Domain 4 meets WI Department of Public Instruction Pupil Service Standards 2, 6
NASP Domain 5: School-Wide Practices
to Support Learning
Novice
Advanced
Novice
Emerging
Practitioner
1. Demonstrates knowledge of basic
school systems and what transpires in
diverse classrooms (general ed, special
ed, alternative ed).
2. Understands the Wisconsin ten
teacher standards.
3. Demonstrates knowledge of and/or
participates in a multi-tiered continuum
of school-based services (ex., RtI for
academics, PBIS)
Internship in School Psychology Manual
Page 20
4. Participates in the development of
evidence-based strategies for effective
school-wide policies and practices (ex.,
discipline, instructional supports, staff
training, program evaluation, grading,
school improvement plans, transition
planning).
NASP Domain 5 meets WI Department of Public Instruction Pupil Service Standards 1, 2, 5, 6
NASP Domain 6: Preventative and
Responsive Services
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
Not
Observed
Established
Practitioner
Advanced
Practitioner
Not
Observed
1. Demonstrates knowledge of principles
and practices related to resiliency and
risk factors in learning and mental health.
2. Demonstrates ability to seek out
appropriate resources to assist with
student and/or family needs (ex.,
resources for homeless families, access to
community health or other services,
abuse resources, etc).
3. Participates in the design,
implementation, and evaluation of
programs that address systematic
problems (ex., school failure, truancy,
dropout, bullying, school violence, youth
suicide, etc)
NASP Domain 6 meets WI Department of Public Instruction Pupil Service Standards 2, 5, 6
NASP Domain 7: Family and School
Collaborations
Novice
Advanced
Novice
Emerging
Practitioner
1. Understands the characteristics of
family, family strengths and needs, family
culture, and family-school interaction
that impacts learning.
2. Helps families to become active
participants in their child’s education by
promoting positive family-school
interactions.
3. Identifies and navigates with sensitivity
diverse cultural contexts and perspectives
that impact family-school communication
and collaboration.
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4. Utilizes evidenced-based problemsolving strategies, consultation,
evaluation methods, and direct/indirect
services to enhance family-schoolcommunity effectiveness in addressing
the needs of children.
NASP Domain 7 meets WI Department of Public Instruction Pupil Service Standards 4, 5, 7
NASP Domain 8: Diversity in
Development and Learning
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
Not
Observed
Established
Practitioner
Advanced
Practitioner
Not
Observed
1. Demonstrates knowledge of principles
and practices related to diversity factors
(i.e., age, gender or gender identity,
cognitive capabilities, social-emotional
skills, developmental level, race,
ethnicity, national origin, religion, sexual
and gender orientation, disability, chronic
illness, language, socioeconomic status).
2. Considers English proficiency when
interacting with culturally and
linguistically diverse students and making
decisions about assessment and
intervention.
3. Provides culturally competent practices
in all areas of service.
NASP Domain 8 meets WI Department of Public Instruction Pupil Service Standards 4, 7
NASP Domain 9: Research and Program
Evaluation
Novice
Advanced
Novice
Emerging
Practitioner
1. Demonstrates knowledge of research
design, measurement, and varied
methods of data collection techniques
used in educational settings.
2. Consumes research material and seeks
information when he/she needs to
increase his/her knowledge base.
3. Participates in the design and analysis
of program evaluation.
NASP Domain 9 meets WI Department of Public Instruction Pupil Service Standards 3
Internship in School Psychology Manual
Page 22
NASP Domain 10: Legal, Ethical, and
Professional Practice
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
Not
Observed
Rarely
Often
Always
1. Understands the comprehensive roles
and functions of the school psychologist
(ex., foundations of school psychology;
ethical, legal and professional standards
related to professional identity; and
effective practice as a school
psychologist).
2. Understands and adheres to legislation
and regulations relevant to education (i.e,
IDEA, 504, NCLB, FERPA, confidentiality,
etc).
3. Seeks ongoing professional
development opportunities (ex., state or
national conferences, workshops,
webinars, etc.)
4. Provides services consistent with
ethical and professional standards in
school psychology.
NASP Domain 10 meets WI Department of Public Instruction Pupil Service Standards 4
Professional Work Characteristics
1. Is appropriately/professionally dressed and well-groomed.
2. Demonstrates reliability in work, attendance, and punctuality.
3. Is organized and demonstrates ability to plan ahead (e.g., preparing for
assessments and meetings, having appropriate materials ready and available).
4. Takes initiative (i.e., commensurate with skills) without being asked.
5. Accepts supervision and incorporates constructive feedback openly and
appropriately.
6. Is tactful and appropriate with teachers, families, and other service providers.
7. Clearly and concisely communicates to a diverse audience, both verbally and in
written format.
Professional Work Characteristics meet WI Department of Public Instruction Pupil Service Standard 7
Internship in School Psychology Manual
Page 23
Comments from Mentor
I have completed the above evaluation and reviewed it with the intern.
________________________________________________
Signature of Mentor
______________
Date
I have reviewed the above evaluation.
________________________________________________
Signature of Intern
_______________
Date
I have reviewed the above evaluation.
________________________________________________
Signature of University Supervisor
________________
Date
After completed, the intern should upload to D2L.
For Intern and University Use:
Intern, Please calculate the following prior to submitting to your university supervisor.
Total number of items rated at Established Practitioner level or higher =
__________
Divided by
Total number of items rated (not counting items rated as n/o) =
Percentage of Items rated at Established Practitioner level or higher =
Internship in School Psychology Manual
__________
Total ___________
Page 24
Appendix F
SCHOOL PSYCHOLOGY UNIVERSITY SUPERVISOR MID-YEAR/FORMATIVE EVALUATION
University of Wisconsin - Stout
Student Name: _________________________________________
University Supervisor:________________________________
Review Date: ________________
Novice
Advanced Novice
Emerging Practitioner
Established
Practitioner
Advanced Practitioner
Student demonstrates
the skills and behaviors
necessary to participate
in and contribute to
relevant activities and
functions; building
competence while
continuing to receive
substantial guidance
and supervision.
Student demonstrates
the skills and behaviors
necessary to
significantly participate
in and substantially
contribute to relevant
activities and functions;
continuing to build
competence while
requiring reduced
levels of direct
supervision. Continued
indirect supervision is
expected.
Student demonstrates
the skills and behaviors
necessary to work
independently;
expanding competence
and building fluency.
Continued indirect
supervision and regular
consultation is
expected.
Student demonstrates
the skills and behaviors
necessary to work
independently while
integrating and
applying the full range
of competencies.
Continued indirect
supervision and
occasional consultation
is expected.
Student demonstrates
the skills and behaviors
necessary to work
independently while
integrating and
applying the full range
of competencies.
Student shows a level
of knowledge, practice,
and leadership
consistent with a highly
reflective practitioner.
Occasional consultation
is expected.
Role and Function
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
1. Understands job duties related to NASP Practice
Model domains.
2. Is able to develop professional goals based on
previous feedback from classes and practicum.
3. Is able to accurately assess his/her own skills in
relationship to the domains and determine which
need skill improvement, expansion, and maintenance.
Case Presentation and Consultation
1. Selects cases appropriate for case consultation.
2. Identifies all aspects of the concern to be
addressed by colleagues
3. Upholds confidentiality.
4. Asks questions of others to help clarify the
presenting problem of others.
5. Offers evidence-based ideas and support for cases.
Internship in School Psychology Manual
Page 25
Personal Health
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
1. Is able to reflect on and analyze the emotions of a
first year professional.
2. Is able to articulate self-care strategies.
Professional Characteristics
Rarely
Often
1. Completes documentation paperwork in a timely fashion.
2. Participates in on-line consultation weekly.
3. Completes quality reflection activities.
4. Seeks university support when appropriate.
5. Clearly and concisely communicates, both verbally and in written format.
Comments
Internship in School Psychology Manual
Page 26
Always
Appendix G
SCHOOL PSYCHOLOGY PORTFOLIO REVIEW
INTERNSHIP UNIVERSITY SUPERVISOR SUMMATIVE EVALUATION
University of Wisconsin - Stout
Student Name: _____________________________________
Review:
Benchmark 2 (Roles and Function)
University Supervisor: ___________________________
Date: _____________________
Benchmark 3 (Practicum)
Benchmark 4 (Internship)
University Supervisor Signature: ______________________________
Using the following performance-based stages as a guide, please rate the portfolio artifacts.
Novice
Advanced Novice
Emerging Practitioner
Established
Practitioner
Advanced Practitioner
Student demonstrates
the skills and behaviors
necessary to participate
in and contribute to
relevant activities and
functions; building
competence while
continuing to receive
substantial guidance
and supervision.
Student demonstrates
the skills and behaviors
necessary to
significantly participate
in and substantially
contribute to relevant
activities and functions;
continuing to build
competence while
requiring reduced
levels of direct
supervision. Continued
indirect supervision is
expected.
Student demonstrates
the skills and behaviors
necessary to work
independently;
expanding competence
and building fluency.
Continued indirect
supervision and regular
consultation is
expected.
Student demonstrates
the skills and behaviors
necessary to work
independently while
integrating and
applying the full range
of competencies.
Continued indirect
supervision and
occasional consultation
is expected.
Student demonstrates
the skills and behaviors
necessary to work
independently while
integrating and
applying the full range
of competencies.
Student shows a level
of knowledge, practice,
and leadership
consistent with a highly
reflective practitioner.
Occasional consultation
is expected.
Minimum Performance Expectation at Internship/Benchmark 4 Evaluation: In order for the candidate to complete
internship, he or she must have 80% of domains rated the Established Practitioner level or higher.
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
NASP Domain 1: Data-Based Decision Making and
Accountability
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 2: Consultation and Collaboration
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
Internship in School Psychology Manual
Page 27
Comments
Novice
Advanced
Novice
Emerging
Practitioner
Established
Practitioner
Advanced
Practitioner
NASP Domain 3: Interventions and Instructional
Support to Develop Academic Skills
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 4: Interventions and Mental Health
Services to Develop Social & Life Skills
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 5: School-Wide Practices to Support
Learning
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 6: Preventative and Responsive Services
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 7: Family and School Collaborations
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 8: Diversity in Development and Learning
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 9: Research and Program Evaluation
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
NASP Domain 10: Legal, Ethical, and Professional
Practice
Reflection:
Yes
No
Artifact 1
Artifact 2
Artifact 3
Comments and Recommendations:
Internship in School Psychology Manual
Page 28
Comments
Appendix H: Outcome-Based Project Description
Introduction and Objective
With emphasis in school systems on evidenced-based methods, school psychologists are becoming responsible for measuring the
impact of practices/methods/services/interventions on students within their school. Therefore, the goal of this project is for each
interning school psychologist to select a method to examine the effect of their practice on student learning, behavior, and/or
achievement. From the options below, interns will complete two projects (one each semester, one behavior and one academic) and
provide a handout and outcome-based artifact for presentation.
Description of Each Option
Option 1: Single-Subject Design for Behavior Intervention (direct or consultative service)
 The intern will conduct an intensive behavioral intervention with one student.
 Interns will collect a quantitative baseline on a behavior, implement a behavioral intervention, and continue to measure
behavior quantitatively throughout the intervention to determine the results of the intervention. As data is collected, it will
be graphed so that visual inspection can aid in the evaluation of the plan.
 The FBA/BSP model is encouraged in order to develop the intervention plan, but other systems of intervention can be used
also.
 Throughout this plan, the intern may act as a consultant by assisting other faculty and staff in the measurement and
implementation of the plan, or the intern may act in a direct service role as they are involved in measuring and implementing
intervention directly.
Option 2: Single/Few-Subject Design for Academic Intervention (direct or consultative service)
 The intern will conduct an intensive academic intervention with one student.
 In order to measure the students’ learning, interns will select an appropriate curriculum-based measurement tool. Interns
will progress-monitor the student’s skills with the CBM over the course of the intervention. As data is collected, it will be
graphed so that visual inspection can aid in the evaluation of the plan.
 Throughout this plan, the intern may act as a consultant by assisting other faculty and staff in the measurement and
implementation of the plan, or the intern may act in a direct service role as they are involved in measuring and implementing
intervention directly.
Option 3: Program Evaluation of a Small Group or Classroom Intervention Program (either behavioral or academic)
 Interns will use an evidenced-based intervention program which is targeted on a small group or classroom. The intervention
program can be academic, social, behavioral, transitional, or focused on building other positive skills.
 Interns could choose a variety of ways to measure the impact of the intervention, examples include: measurement of
behavior, group testing results, criterion-referenced assessment, surveys, etc. Measurement needs to be feasible for a small
group.
 Data will need to be graphed and/or charted so that results can be examined and evaluated.
Option 4: Program Evaluation of a School-Wide Intervention Program (either behavioral or academic)
 Interns will implement an evidenced-based universal program focused on school-wide or system-wide intervention. The
intervention program can be academic, social, behavioral, transitional, or focused on building other positive skills.
 Interns could choose a variety of ways to measure the impact of the intervention program, examples include: measurement
discipline referrals, measurement of special education referrals, group testing results, criterion-referenced assessment,
surveys, etc. Measurement needs to be feasible for a system.
 Date will need to be graphed and/or charted so that results can be examined and evaluated.
Option 5: Approval for another project
 Interns may seek approval for another kind of project. Please contact the university supervisor for details.
Presentation and Outcome-Based Artifact
 At the intern’s second internship seminar, the project will be presented using the outcome-based artifact as a handout.
 The presentation and artifact should include:
 Description of the ‘problem’: Why was this project selected? Why was this subject, small group, or system
selected?
 Description of the intervention: What did you choose for an intervention or program and why?
 Description of the measurement technique: What did you use to measure the impact of the intervention or program?
 Description of the results: Did the intervention or program work? And how do you know?
Internship in School Psychology Manual
Page 29
Appendix I: Outcome-Based Project Rubric
Student: _______________________________
Date: _______________
University Supervisor: __________________________________
Is this artifact?
Academic
Seminar 1/Midterm
Seminar 2/Final
Behavioral
Description of Artifact (please attach also):
1. Problem Identification & Analysis: Did the
intern address a problem related to student
performance and appropriately assess the
situation?
0- No problem
addressed
2. Plan Development and Implementation:
Did the intern select and utilize a research-based
intervention/method?
0- No
intervention
3. Results and Evaluation: Did the intern select
and describe a measurement technique which
would show growth and change over time in the
subject(s)?
0- Did not
measure
change
4. Data Analysis: Did the intern display and
analyze data to determine the effect of the
intervention?
0- No data or
analysis
5. Outcome: Did the data show a direct,
measurable, and positive impact on children,
families, and/or school?
0- No positive
outcome
shown
Internship in School Psychology Manual
1- Problem
addressed, but
no assessment
2- Both
problem and
assessment
1- Intervention
but not
researchbased
1- Selected
weak
measurement
tool for
problem
1- Data was
insufficiently
displayed to
make analysis
1- Positive
outcome
shown, but
issues with
measurement
2- Utilized a
researchbased
intervention
2- Appropriate
measurement
tool, but data
lacking
3- Appropriate
tool and
sufficient data
to show
outcome
2- Data is
present but no
analysis made
3 – Data
present and
analysis made
2- Positive
outcome and
sound
measurement
Page 30
Appendix J: School Psychology Log
Name:
Assessment
Year:
Semester:
Total Hours
Evaluation for SPED (Cognitive/Academic/Social-Emotional)
Assist in Evaluation for Community Referral (mental health, ADHD, AODA)
Evaluation for Academic Intervention Planning (curriculum-based measurement)
Evaluation for Behavioral Intervention Planning (FBA)
Counseling & Intervention
0
0
0
0
Counseling Individuals
Co-facilitating Counseling Groups
Academic Intervention Implementation
Behavioral Intervention/ Prevention Implementation
Crisis Intervention / Prevention Implementation
Assisting in Systems-Wide Intervention/ Prevention Programs (classroom, school)
Consultation & Collaboration
Consultation & Collaboration with Teachers/ Staff
Observing Consultation & Collaboration with Community Agencies
Consultation & Collaboration with Families
Professional Policies & Development
0
0
0
0
0
0
SPED paperwork/ Case Management (calls, referrals)
Assisting with Interagency Case Management
Observing/ Co-facilitating Team Meetings (IEPs, student assistance teams)
Conference, Workshop, In-service Training Attendance
Assisting with Presenting/ Developing Workshops/Trainings
0
0
0
0
0
Time in Supervision
0
SEMESTER TOTAL
0
0
0
0
Diverse Populations - Estimate percentage of population worked with for semester
Caucasian
Latino/ Hispanic
Black/ African American
Asian/ Pacific Islander
American Indian
GLBT
Internship in School Psychology Manual
Page 31
39