General Internship Forms

IMPORTANT

These forms are for Rehabilitation Counseling; Clinical Mental Health Counseling; and Marital, Couple and Family Counseling students only. School Counseling internship forms can be found here.

Your Academic advisor is the faculty advisor you have had since you entered the program. Your Internship Supervisor is the PSU faculty member who completes site visits and assigns grades for your internship. Your Site Supervisor is your supervisor at your internship location.

The Clinical Director is Dr. Susan Halverson-Westerberg.

Submit to clinical director

Internship application Form A

Proof of insurance

Signed internship agreement Form B

Submit to your internship supervisor at the end of fall quarter:

Expectations of Supervisory Process form Form G

Submit to your internship supervisor at end of each quarter:

Internship Hour Summary, initialed by site supervisor Form E

Intern Performance Evaluation form, signed by site supervisor Form J

Submit to your internship supervisor at end of internship:

Record of Supervision and Training inservice hours Form D (final quarter)

Internship Hours Summary form Form E

Student Evaluation of Internship and Supervision Experience Form I

Intern Performance Evaluation form (final quarter) Form J

Other forms and information that may be helpful:

Daily record of client contact hours Form C-1 or blank version of C-1

Weekly record of client contact hours Form C-2 or blank version of C-2

Consent to be Observed or Tape Recorded and statement Form K

For internship and application information, click here.