COUNSELING AND EDUCATION
Handbook of Field Experience
Practicums I, II and III
Education and Human Services
Substance Abuse Counseling and
Education
Field Experience Practicums I, II and III
Professional
Liability Insurance
Licensure
· Practicum Procedures
Class Prerequisites
Applying for Field Experience Practicum
Field Experience
Practicum Placement
Time Requirements
Required Reading
Practicum Student
Evaluation
Practicum Site
Evaluation
Grading
· The Practicum Experience
Duties and
Responsibilities of the Practicum Coordinator
Duties
and Responsibilities of the Practicum Student
Duties and
Responsibilities of the Agency’s
On-Site Supervisor
Guidelines for the Nova
Field Experience Practicum
Instructor
Competencies to be
Assessed During the
Field Experience Practicum
· Appendices
Field Experience
Practicum Checklist
List of All Field
Experience Forms
Application for Field Experience Practicum
Field Experience
Practicum Site Approval
Field Experience
Practicum Approval
Log of Contact Hours
Field Experience
Practicum Student Evaluation (Midterm)
Field Experience
Practicum Student Evaluation (Final)
Field Experience
Practicum Site Evaluation
Consent for Audiotaping
Semester Requirements
The Field Experience
Practica at Nova Southeastern University is that facet of the Master’s Program
in which the student is expected to adapt and integrate his or her educational
experience into a practical and knowledgeable style of counseling. Supervised counseling
is an invaluable tool and experience that supports the future counselor so that
he or she may learn practical methods in order to function effectively as a
counselor in present and future employment. It is usually the first opportunity
for the counselor-trainee to apply knowledge learned from academic courses to
an actual counseling site.
Three field
experience practicums are provided within the program to furnish students the opportunity
of working directly with client populations within a three (3) consecutive
semester time frame. Students are required to complete all three (3)
consecutive semester field experience practicums at the same site.
Placements at the Practicum site must be in an approved site, and must be
approved by the Practicum Coordinator prior to beginning Field Experience
Practicum I.
Students entering
field expertise are expected to obtain and maintain their own professional
liability insurance. Proof of liability insurance must be provided to the
Practicum Coordinator and to the site supervisor or administrator. Insurance
can be obtained through the National Association for Drugs and Alcohol
Counselors (NAADAC). All students are required to abide by the Ethical
Standards of the NAADAC, policies and procedures of the Fischler
School of Education and Human Services, and any other relevant code of ethics.
Students must also follow all rules and regulations of the agency where his or
her Practicum will be completed.
Proof of professional
liability insurance must be provided
to the Practicum Coordinator no later than the ending of the second calendar
week of the Practicum course for Field Experience I Practicum. Students
that cannot provide proof of insurance by this due date will be automatically
withdrawn from the course by the program instructor and he or she may need to
re-register for this course the following time it is scheduled.
Students seeking
certification or licensure in their states must contact their appropriate state
agencies or boards in order to determine the requirements for licensure. It
is the student’s responsibility to obtain any and all of the information needed
from their regulating state agency regarding licensure/certification
requirements.
In addition, students
may also wish to contact the following regulatory agencies to obtain
information on additional certifications:
National Board of
Certified Counselors (NBCC)
Certified Addiction
Professional (CAP)
Master’s Addictions
Counselor (MAC)
Field
Experience Practicum Procedures
APRA 502: Individual Assessment, Evaluation and Rehabilitative Strategies in Substance Abuse Counseling
APRA 503: Human
Growth and Development Theories and Prevention Programming
SACA 507: Family Systems
SACA 504: Group
Theory and Practice
SACA 508: Counseling Theory and Practice
SACA 509: Personality Theory
SACA 511: Psychopathology and Abnormal
Psychology
*NOTE: All classes listed above must be completed with a grade of
B or better.
† It is strongly recommended that DEVA 508
Legal, Ethical, and Professional Standards in Substance Abuse and Counseling be
successfully completed prior to Field Experience I. If this class is not taken
prior to the matriculation in Field Experience I, then it is mandatory this
class be taken concurrently with Field Experience I.
†† Those students that do not meet the
requirements for matriculating in the Field Experience Practicum must contact
the Practicum Coordinator for approval prior to completing an application form.
The student is
required to complete the Application for
Field Experience Form (see
Appendices, Form 1) once he or she is considering registering for Field
Experience Practicum. This form is an official document. Three copies of
this form must be forwarded to the Program Coordinator by the specified date.
One copy of your resume must accompany and be attached to each copy of the
application form. Once approved or rejected, one copy of this form will be
returned to the student, one copy will be filed in the student’s records, and
one copy will be forwarded to the Field Experience Practicum Instructor. Students
are neither authorized nor allowed to contact any agency or to register for
Field Experience until their application is approved. Incomplete or
inaccurate applications will be returned to the student.
This form must be received by the Practicum
Coordinator no later than the ending of the second calendar week of the
Practicum course for Field Experience I Practicum. Forms not received by
this due date may will result in the student being withdrawn from the class by
the Practicum instructor and he or she may need to re-register for this course
the following time it is scheduled.
** It is strongly recommended that students begin this process about 6-8 weeks prior to the beginning of this module.
Registration
information will be provided prior to the beginning of the field experience.
Field Experience Practicum
sites allow the student to demonstrate his or her various competencies,
qualifications and abilities during their training program (see list on page
15). Students must realize that certain Practicum sites may require
additional specialized clinical skills.
The student cannot do
his or her field experience Practicum in a private practice or in the same job
he or she presently holds. If the student would like to do his or her Practicum
in a private practice, special clearance and approval must be obtained prior
to registration from the Practicum Coordinator. In addition, if the student
would like to do his or her Practicum at the same site where he or she is
currently employed, it must be done in a different department or unit and must
be supervised by a qualified person unrelated to his or her present employed
position.
Placement Procedure
1. After the student’s application for field experience Practicum placement has been approved by the Practicum Coordinator, the student must determine which agency will best meet his or her needs.
2.
In order to evaluate
the site as a possible field experience Practicum site, the Practicum
Coordinator requires that a mission statement, informational brochure or
pamphlet produced by the agency, supervisor resume, and name and phone number
of a contact person in order to either approve or reject a Practicum site be
forwarded to the Program Office. Ideally, the contact person would be the
supervisor, but a clinic or hospital administrator may suffice, dependent upon
the Practicum site (see Appendices, Form 3).
3.
Once the site has
been approved by the Practicum Coordinator, it is the student’s responsibility
to contact the agency for an interview. Ideally, the student has contacted and
expressed his or her interest in the site after permission to begin the Field
Experience Practicum has been granted. The student will bring a copy of his or
her completed resume to the interview to be given to the person(s) with whom he
or she is interviewing. It is during this interview the student will discuss
his or her schedule and competencies required by the site.
4.
The student will
complete the Practicum Site Approval Form
(see Appendices, Form 4) and will request the agency’s administrator and
on-site supervisor to sign this document. The student will give the signed site
approval form to the Program Coordinator prior to the commencement of the
first field experience seminar class.
Field Experience Practicum On-Site Supervisor
The
major criterion for the field experience Practicum site selection is the
credentials of the agency’s on-site supervisor. This individual must be a
master’s level or higher and must have a current license in the field of
Psychology or in a related human services field.
Once
the Application for Field Experience has been approved by the Practicum
Coordinator, the student is required to forward the resume of the potential
on-site supervisor to the Practicum Coordinator. Based on the credentials of
this supervisor, the Practicum Coordinator will either approve or reject the
site (see Appendices, Form 3). If there is more than one supervisor at the
site, then all resumes must be forwarded to the Practicum Coordinator for
approval. The student is required to be supervised by the same supervisor
throughout the same Practicum term.
Each field experience
Practicum course requires the student to complete a minimum of one
hundred-sixty (160) clock hours of work during each term of enrollment in one department
or unit at an agency. The student is expected to work a minimum of ten (10)
hours per week for sixteen (16) weeks for each term. If the student elects to
work more than ten hours per week, it should be discussed during the initial
interview. Any additional hours the student accumulates over the required
time of one hundred-sixty hours will not reduce the amount of time required for
successful completion of the subsequent semester. Additional hours the
student has worked will not reduce the sixteen (16) week requirement.
At least five (5)
hours per week should be spent on direct services, along with 1 (one) hour of
weekly supervision. A log of contact hours signed weekly by the supervisor must
be kept by the student (see Appendices, Form 5). This log will be used to
verify the amount of hours worked by the student. It is advisable that the
student keeps a copy of this log for his or her own records.
The student will be
responsible for reading the required material assigned for each semester.
Discussions based on this material will be conducted by the Practicum
instructor. Two assignments will be assigned each Practicum term by the Nova
Practicum instructor. Students are expected to complete these assignments by
their due dates.
Each student will be
evaluated by his or her on-site supervisor on two separate occasions per Field
Experience term (see Appendices, Forms 6 and 7). The Midterm evaluation must be
received by the Practicum Instructor by the end of the ninth (9) week. Midterm
evaluations not received by the ninth (9) week will be given an “F” for that
evaluation. It is the student’s responsibility to encourage the on-site
supervisor to mail the evaluation form to the Nova instructor immediately
following the semester midpoint and on completion of each semester of Practicum
experience. The final evaluation must
be received by the Practicum Instructor no later than two (2) weeks after the
end of the term. Any final evaluation not received two (2) weeks after the end
of the term will be given an “F” for the evaluation.
The student must
complete the Practicum Site Evaluation Form (see Appendix, Form 8) at the
completion of each Practicum term and submit one copy to the Nova Southeastern
University Practicum instructor and another copy to the Practicum Coordinator. The Practicum site evaluation must be received by the
Practicum Instructor no later than two (2) weeks after the end of the term. Any
final evaluation not received two (2) weeks after the end of the term will be
given an “F” for the evaluation.
In order to receive credit for the field experience, all of the competencies listed in subsequent sections of this Handbook must be evaluated as having been satisfactorily completed. In addition, all of the required forms must be completed and forwarded to the Practicum Instructor to avoid receiving a failing (“F”) grade. A letter grade (A, B, C, D, F) will be given at the completion of each Field Experience Practicum I, II and III.
The Midterm evaluation must be received by the Practicum Instructor by the end of the ninth (9) week. Midterm evaluations not received by the ninth (9) week will be given an “F” for that evaluation.
The final evaluation
must be received by the Practicum Instructor no later than two (2) weeks after
the end of the term. Any final evaluation not received two (2) weeks after the
end of the term will be given an “F” for the evaluation.
The Practicum site evaluation
must be received by the Practicum Instructor no later than two (2) weeks after
the end of the term. Any final evaluation not received two (2) weeks after the
end of the term will be given an “F” for the evaluation.
The log of contact hours must be received by the Practicum Instructor no later than two (2) weeks after the end of the term. Any log not received two weeks after the end of the term will be given an “F” for the completion of hours.
All assignments are expected to be received by the Practicum Instructors by their due dates. Any assignments not received by their due dates without prior approval by the Program Instructor will result in a lower grade, possibly receiving an “F” for that assignment.
Final grades of “C” or lower
in any Field Experience term will result in the student re-registering and
repeating that Field Experience course.
No one is allowed to receive
an incomplete (“I”) grade in any of the Field Experience courses.
Duties and Responsibilities
of the
Practicum Coordinator
Agencies that choose to participate in the training of future counselors enjoy an important status in shaping the future of the profession. These agencies should have staff members who are qualified and are willing to accept and share the responsibility of training students. These staff members should not only be professionally able and skillful, but aware of innovative and novel concepts in the field of counseling.
The Practicum Coordinator’s major responsibility is to determine if the selected field experience Practicum sites are appropriate for the student. Once approved, the Practicum Coordinator assists the student by becoming available and acting as the liaison between the School of Substance Abuse Counseling and Education and the student. The Practicum Coordinator plays an important and pivotal role in the success of the student’s field experience Practicum. In addition, the Practicum Coordinator has the following duties and responsibilities:
1. Send letters and make telephone calls to agency administrators at appropriate times.
2. Meet with the Nova instructor and maintain contact with field experience Practicum students at appropriate times to insure appropriate placements.
3. Distribute handbooks to students, collect field experience Practicum applications.
4. Act as a liaison between students and agencies during the placement process.
5. Evaluate field experience Practicum sites based on feedback from students, faculty, and administrators and respond accordingly.
6. Solve problems that should arise at Practicum sites involving Nova program students.
7. Provide feedback to Nova program students based on evaluation form completed by on-site supervisor.
Duties and Responsibility of
the
Field Experience Practicum
Student
An agency accepts a field experience Practicum student realizing the needs and abilities of the student along with the realization that its own needs and those of the community it serves must also be met. Because of this, the field experience Practicum student is expected to perform assigned duties in a highly professional manner tempered with a warm and caring attitude. The Practicum student is expected to meet the specific requirements listed below:
1. Become familiar with Practicum Handbook, Practicum procedures, and agency policies and procedures.
2. Perform appropriate job related functions in the placement agency as directed by the on-site supervisor.
3. Demonstrate the competencies listed at the end of this section of the Handbook.
4. Maintain a log of contact hours performed at the Practicum site to be submitted to the Nova field experience Practicum instructor (see appendices, Form 5).
5. Read counseling texts and journal as required by Nova field experience Practicum instructor.
6. Complete all written requirements and assignments required by Nova field experience Practicum instructor.
7. Confer with the Nova Practicum instructor and with the agency’s on-site supervisor when necessary. Any problems at the Practicum site that cannot be resolved there, must be discussed with the Nova field experience instructor. If the problem persists, then it must be presented by the Practicum student to the Practicum Coordinator.
8. Attend all field experience Practicum seminars with the Nova field experience Practicum instructor.
9. Based on feedback provided by on-site supervisor, Nova field experience Practicum instructor, and Practicum Coordinator, the Practicum student should continuously work on improving his or her performance.
10. At the completion of each Field Experience Practicum term, a Practicum Site Evaluation Form (see appendices, Form 8) should be completed and collected by the Nova field experience Practicum instructor.
11. Field Experience Practicum students are responsible for the completion of their midterm and final evaluation forms by their on-site supervisor. It is the student’s responsibility that the Nova field experience Practicum instructor receive the evaluations by the designated dates.
Duties and Responsibilities
of the
On-Site
Supervisor
The on-site supervisor is expected to provide the necessary on-site supervision required to maintain a high level of professional and ethical behavior. The on-site supervisor has the major responsibility of creating a positive learning experience for the Practicum student. The on-site supervisor is expected to meet the specific requirements listed below:
1. Introduce the field experience Practicum student to the counseling staff and other appropriate staff members.
2. Familiarize the field experience Practicum student with the agency’s program rules, regulations, traditions, and social codes.
3. Provide the field experience Practicum student with a place to work which offers privacy for the purpose of counseling clients to the extent available.
4. Provide opportunities for the field experience Practicum student to demonstrate the competencies listed at the end of this section of the Handbook. This includes assigning a case load to the Practicum student.
5. When available, provide opportunities for the field experience Practicum student to attend staff-related in-service training, consultations, program meetings, and any other activities that may be beneficial to the Practicum student.
6. Help the field experience Practicum student relate the experiences of the Practicum site to theoretical constructs.
7. Follow the activities of the field experience Practicum student closely, providing the student with regularly schedule supervision at a minimum of one (1) hour per week, face-to-face.
8. At the semester midpoint and completion of each semester term, assess the Practicum student’s performance on the competencies (see appendices). Mail each completed evaluation immediately to the Nova Practicum instructor who is ultimately responsible for issuing the final grade. The field experience Practicum student will provide the name and address of that individual.
Field Experience Practicum
Instructor
The Nova instructor provides the educational coordination of the student’s field experience Practicum program. In addition, the Nova instructor :
1. Conduct a one-hour biweekly seminar. Schedule for these seminars will be provided upon registration for the course.
2. Review with the field experience Practicum student the ethical standards for professional behavior and ethical issues, especially confidentiality, related to audio-taping (see appendices, Form 9).
3. Assist the field experience Practicum student integrate theoretical constructs with clinical and ethical issues.
4. Supervise individual, couples, family, and group counseling through audio tape analysis, class presentations, and written reports.
5. Review the field experience Practicum student’s log of contact hours and reports. This includes helping the student evaluate his or her experiences and to determine areas of strengths and weaknesses.
6. Hold phone conferences with student and on-site supervisor when necessary.
7. Assess the field experience Practicum student’s performance on the competencies (listed in Handbook) in conjunction with feedback from the on-site supervisor.
8. Review and evaluate assignments assigned to the field experience Practicum student. Along with any seminar homework assigned, the Nova Practicum instructor is required to evaluate the competencies for each student on a semesterly basis (see competencies list).
Field Experience Practicum
Coordinated efforts between the Agency Administrator, On-Site Supervisor, Practicum Coordinator, and Nova Instructor expect to produce a growth in applied knowledge and skills for the Practicum student. The Fischler School of Education and Human Services at Nova Southeastern University appreciates the contributions made by the agencies and on-site supervisors and anticipate that the field experience Practicum students will contribute positively to their sites by becoming assets to the agency.
The field experience Practicum student will demonstrate his or her proficiency in the following competencies each field experience Practicum semester. The performance demonstrated will be assessed by the on-site supervisor and the Nova Practicum instructor. The on-site supervisor will assess these competencies using the Practicum Evaluation forms, due at Midterm and at the end of the semester.
A. The field experience Practicum student will demonstrate the ability to integrate information from various sources in order to accurately conceptualize and develop the most appropriate treatment plan for each client. The student is required to submit to the Nova instructor a treatment plan for one client that he or she is counseling; whether the client is seen in individual, family, group or couples counseling. Due to the nature of addictions, the treatment plan may need to be continuously updated. Because of this, each subsequent updated version pertaining to the same client will also be forwarded to the Nova instructor. Each semester, the Practicum student is required to submit a treatment plan for an additional client and continue submitting revised treatment plans for each client. Thus, by the end of the final field experience Practicum semester, the Practicum student should have submitted three (3) treatment plans with their updates and revisions to the Nova instructor, one per semester.
B. The field experience Practicum student will demonstrate skills and abilities in individual, couples, family, and group counseling. Students are expected to be assigned clients as part of the Practicum experience. Each student is required to submit two audiotape recordings each semester of counseling sessions conducted with two different clients. One of the two audiotape recordings must be of a group session. Written consent for the tape recordings must be obtained from each client (see appendices).
C. One written narrative report per field experience semester of the counseling experiences must be submitted to the Nova instructor. Although the following information should be included in the report, the report must not be limited by this:
1. Identifying Data (remember confidentiality)
2. Reason for Referral
3. Complete history (medical, legal, social, academic, etc.)
4. Case Conceptualization
5. Treatment Plan
6. Counseling Procedures
7. Outcome Assessment
8. Summary, Conclusions, Recommendations
D. The field experience Practicum student will demonstrate ethical and professional behavior in accordance the American Counseling Association and the Code of Ethics for Mental Health Counselors along with policies and procedures from Nova Southeastern University and the Practicum site.
There is no special task available to evaluate ethical standards and behavior during the field experience Practicum, but instead, it is an expected behavior that should be self-evident. Students are expected to follow ethical codes of NAADAC, and are encouraged to contact them to obtain the most recently printed code of ethics.
Appendices
First Edition
June, 2000
Prior to beginning Field
Experience Practicum
Check when each procedure listed below is completed.
˙ Application for Field Experience Practicum (Form 1)
(to Practicum Coordinator)
(___) Resume attached to application (Form 2)
˙ Site Approval Form (Form 3)
(to Practicum Coordinator)
(___) Supervisor Resume
(___) Site Informational Brochure/Pamphlet
(___) Site Mission Statement
(___) Name and Phone Number of Contact Person
˙ Contact Agency for Interview
˙ Interview with Contact Person/Supervisor
(___) Discuss schedule
(___) Competencies
(___) Responsibilities required by supervisor
(___) Department or unit to work in
˙ Accept position
˙ Field Experience Practicum Approval Form (Form 4)
(to Practicum Coordinator)
˙ Proof of Professional Liability Insurance provided to Practicum Coordinator
Field Experience Practicum I
˙ On-site supervisor completes and returns midterm student evaluation to
Nova Southeastern University Practicum instructor.
˙ Submit log of contact hours to Nova Practicum instructor at end of term.
˙ Complete and submit Practicum Site Evaluation to the Nova Practicum instructor and Program Coordinator.
˙ On-site supervisor completes and returns final student evaluation to Nova Practicum instructor
˙ See Form 10 for additional assignments required.
Field Experience Practicum
II
˙ On-site supervisor completes and returns midterm student evaluation to
Nova Southeastern University Practicum instructor.
˙ Submit log of contact hours to Nova Practicum instructor at end of term.
˙ Complete and submit Practicum Site Evaluation to the Nova Practicum instructor and Program Coordinator.
˙ On-site supervisor completes and returns final student evaluation to Nova Practicum instructor
˙ See Form 10 for additional assignments required.
Field Experience Practicum
III
˙ On-site supervisor completes and returns midterm student evaluation to
Nova Southeastern University Practicum instructor.
˙ Submit log of contact hours to Nova Practicum instructor at end of term.
˙ Complete and submit Practicum Site Evaluation to the Nova Practicum instructor and Program Coordinator.
˙ On-site supervisor completes and returns final student evaluation to Nova Practicum instructor
˙ See Form 10 for additional assignments required.
LIST OF ALL FIELD EXPERIENCE
PRACTICUM FORMS
Form
1 *Application for Field
Experience
Form
2 *Guidelines for Student
Resume
Form
3 *Field Experience Site
Approval Form
Form
4 *Field Experience
Practicum Approval Form
Form
5 Log of Contact Hours
Form
6 Student Evaluation;
Semester Midpoint
Form
7 Student Evaluation;
Final Midpoint
Form
8 Site Evaluation
Form
9 Consent for Audio Tape
Recording
Form
10 Semester Requirements
Checklist
*
Forms to be completed prior to the commencement of Field Experience I.
Form 1
APPLICATION FOR
FIELD EXPERIENCE
Field-Based Master’s Program
Fischler School of Education and
Human Services
School of Substance Abuse Counseling and
Education
Directions: Type or legibly print all information. Please submit original and two copies to the Practicum Coordinator. Current student resume must also attached to each copy of this application.
1. Name:_____________________________________________________
Last First Middle
2. Address: ___________________________________________________
Street Apt #
___________________________________________________________
City State Zip Phone
e-mail: _______________________________
3. SS#: ________________________________
4. Check all of the School of Substance Abuse Counseling and Education Master’s Program required courses you will have successfully completed (grade B or better) prior to the beginning of the first Field Experience Practicum.
b. ____ APRA 502: Individual Assessment, Evaluation and Rehabilitative
Strategies in Substance Abuse Counseling
c. ____ APRA
503: Human Growth and Development
Theories and
Prevention Programming
d. ____ SACA
507: Family Systems and the Substance
Abuse Counselor
e. ____ SACA 504: Group
Theory and Practice
f. ____ SACA
508: Counseling Theories and Practice
Application
for Practicum, Page 2
g. ____ SACA
509: Personality Theory
h. ____ SACA
511: Psychopathology and Abnormal
Psychology
i. ____ SACA
505 Issues in Clinical Supervision
j. ____ DEVA
508:* Legal, Ethical, and Professional Standards in
Substance Abuse and Counseling
k. ____ DEVA
509: Social and Cultural Issues in
Counseling and
Prevention Programming
l. ____ SACA
512: Career and Lifestyle Assessment in
Addictions and
Counseling
m. ____ MGTA 510: Foundations of Substance Abuse and Mental Health
Counseling in Community Settings
n. ____ MGTA 511 Program Evaluations and Research Methods for
Counselors
o. ____ MGTA 512 Management of Medical Treatment of Addictions
p. ____ DEVA 510 Human Sexuality
* If this course is not completed prior to the beginning of the Field Experience, it is mandatory that it be taken concurrently with Field Experience I.
5. Identify all of the elective courses you have successfully completed prior to the beginning of the first Field Experience Practicum.
a. ____ ___________________________________________________
b. ____ ___________________________________________________
c. ____ ___________________________________________________
d. ____ ___________________________________________________
6. List all officially approved graduate courses transferred from other universities. List the prefix, course number, title and grade:
7. List all licenses and/or certifications obtained and the dates they were conferred:
________________________________________________________________
________________________________________________________________
Application
for Practicum, Page 3
8. I, _______________________________, agree to and understand that I am a guest within the agency where I will be doing my field experience Practicum and I agree to abide by its rules and regulations. I agree and understand I am to exhibit professional and ethical behavior at all times, and will abide with the Ethical Standards of the American Counseling Association.
Student’s Signature Date
9. Approval: Full (____) Conditional (____)
Conditional approval because ___________________________________
Practicum Coordinator Signature Date
10. Denial because ______________________________________________
Practicum Coordinator Signature Date
1 copy to student
1 copy to Practicum
instructor
1 copy to student records
June,
2000
Form 2
A professional and informational resume is a vital and important tool in opening doors to any organization. It is important that your resume include the information that a prospective user of your services will be needing. Three copies of your resume are required, one attached to your Application for Field Experience.
1 copy to On-site supervisor
1 copy to Agency administrator
1 copy to Nova field experience Practicum instructor
1 copy for your own records
Sample Resume
John Jones
555 This Road
Titus, Alabama 44534
(305) 555-5555
EDUCATION
B.S. List Major, Honors, University, Year
M.S. (If conferred) List Degree, Honors, University, Year (or anticipated year)
PROFESSIONAL
AFFILIATIONS
American Counseling Association, Student Member
HONORS AND AWARDS
Phi Beta Kappa
Psi Chi National Honor Society
PROFESSIONAL
EXPERIENCE
List most recent relevant experience
ADDITIONAL
EDUCATION AND WORKSHOPS
Recent workshops attended or certifications received. List most recent relevant workshops and date of certifications.
References
Furnished Upon Request
Form 3
FIELD EXPERIENCE
Please attach all of the following required information to this form:
˙ Supervisor(s) Resume
˙ Site Informational Brochure / Pamphlet
˙ Name and Phone Number of Contact Person
˙ Mission Statement for Site
________________________ will be working at __________________________
Name of Student Name of Department
working primarily with ______________________________________________ .
Type of population
I certify that if I am doing my Practicum at my same place of employment, I will be placed in a different unit or department and will be supervised by a qualified person unrelated to my employed position.
Based on the attached information relating to the proposed Practicum site,
________________________________, this site is:
Name of Agency
˙ approved ˙ rejected
as a Field Experience Practicum site for ________________________________
Name of Student
___________________________________ _____________________
Practicum Coordinator Signature Date
June,
2000
Form 4
FIELD EXPERIENCE PRACTICUM APPROVAL FORM
Please sign this form and return it to the field experience Practicum student who will forward it to the Nova Southeastern University Field Experience Practicum Coordinator of the Fischler School of Education and Human Services, School of Substance Abuse Counseling and Education.
_______________________________________________
agrees to accept
Name of Agency
___________________________for
a counseling field experience Practicum
Name of Student
located at
_____________________________________________________
Street
City State Zip
for the period of
________________________________________ through
Month Year
Month Year
Approved for the
Agency by:
Administrator or Representative Date
On-Site Supervisor Date
June,
2000
Form 5
Check One: Name:
__________________________
Cohort:
_________________________
(___) Field Experience Practicum I
(___) Field Experience Practicum II Agency: ________________________
(___) Field Experience Practicum III
Date at Site Activity Time in Activity
(individual, group, family,
record-keeping, staff
meetings, supervision,
training seminars, etc.)
Week 1
On-Site Supervisor Signature Verifying Information Date
Week 2
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 3
On-Site Supervisor Signature Verifying Information Date
Week 4
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 5
On-Site Supervisor Signature Verifying Information Date
Week 6
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 7
On-Site Supervisor Signature Verifying Information Date
Week 8
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 9
On-Site Supervisor Signature Verifying Information Date
Week 10
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 11
On-Site Supervisor Signature Verifying Information Date
Week 12
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 13
On-Site Supervisor Signature Verifying Information Date
Week 14
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
Week 15
On-Site Supervisor Signature Verifying Information Date
Week 16
________________________________________________________________
On-Site Supervisor Signature Verifying Information Date
June,
2000
Form 6
Semester Midpoint
Check One: Name:
__________________________
(___) Field Experience Practicum I Cohort: _________________________
(___) Field Experience Practicum II
(___) Field Experience Practicum III Agency: ________________________
Agency’s On-Site Supervisor: ______________________________________
This form must be completed prior to the midpoint of each semester of field experience Practicum and mailed to the Nova field experience Practicum instructor. (Name and address of the Nova field experience Practicum instructor will be provided by the Practicum student.)
Use the five-point scale below to rate the Practicum student’s level of performance in each of the areas listed. Make comments as needed.
1–Poor 2-Fair 3-N/A* 4- Satisfactory 5-Excellent
(*N/A means does not apply, or unknown)
A. Clinical Skills: Overall Rating: _______
1. (___) Evaluation and diagnostic skills
2. (___) Conceptualization of cases and its maintaining factors
3. (___) Provide appropriate treatment interventions
4. (___) Establish rapport in therapeutic relationships
5. (___) Clearly communicating (orally and written) observations,
impressions, and recommendations.
6. (___) Ability to accept feedback
7. (___) Crisis intervention
Comments:
B. Intellectual Characteristics: Overall Rating: _______
1. (___) Scholarly commitment
2. (___) Problem solving
3. (___) Application of knowledge to difficult situations
4. (___) Writing and language skills
Comments:
C. Professional Responsibility: Overall Rating: ________
1. (___) Recognition and application of ethical guidelines
2. (___) Seeks supervision when faced with difficult situation
Comments:
D. Personal Characteristics: Overall Rating: _________
1. (___) Emotionally adjusted and demonstrates maturity
2. (___) Sensitivity to cultural issues
3. (___) Reliable
4. (___) Organizing and Planning ability
Comments:
E. Interpersonal Characteristics: Overall Rating: __________
1. (___) Positive relationship with clients
2. (___) Positive working relationship with family of clients
3. (___) Positive working relationship with administrators
4. (___) Positive working relationship with professional staff
5. (___) Positive working relationship with clerical staff
6. (___) Positive working relationship with supervisor
7. (___) Respect for ideas and opinions of others
Please comment on the Practicum student’s strengths and weaknesses:
Strengths:
Weaknesses:
Overall Grade: _________________________________________________
Grade Supervisor Signature Date
A – Superior Performance W – Withdrawal
B – Satisfactory Performance I – Incomplete
C – Fair Performance NC – No Credit
F – Deficient Performance
Supervisor’s Signature Date
I have read and discussed this evaluation with my on-site supervisor.
Field Experience Practicum Student’s Signature Date
June,
2000
Form 7
STUDENT EVALUATION
Final
Check One: Name:
__________________________
(___) Field
Experience Practicum I Cohort: _________________________
(___) Field Experience Practicum II
(___) Field Experience Practicum III Agency: ________________________
Agency’s On-Site Supervisor: ______________________________________
This form must be completed prior to the midpoint of each semester of field experience Practicum and mailed to the Nova field experience Practicum instructor. (Name and address of the Nova field experience Practicum instructor will be provided by the Practicum student.)
Use the five-point scale below to rate the Practicum student’s level of performance in each of the areas listed. Make comments as needed.
1–Poor 2-Fair 3-N/A* 4- Satisfactory 5-Excellent
(*N/A means does not apply, or unknown)
F. Clinical Skills: Overall Rating: _______
1. (___) Evaluation and diagnostic skills
2. (___) Conceptualization of cases and its maintaining factors
3. (___) Provide appropriate treatment interventions
4. (___) Establish rapport in therapeutic relationships
5. (___) Clearly communicating (orally and written) observations,
impressions, and recommendations.
6. (___) Ability to accept feedback
7. (___) Crisis intervention
Comments:
G. Intellectual Characteristics: Overall Rating: _______
1. (___) Scholarly commitment
2. (___) Problem solving
3. (___) Application of knowledge to difficult situations
4. (___) Writing and language skills
Comments:
H. Professional Responsibility: Overall Rating: ________
3. (___) Recognition and application of ethical guidelines
4. (___) Seeks supervision when faced with difficult situation
Comments:
I. Personal Characteristics: Overall Rating: _________
1. (___) Emotionally adjusted and demonstrates maturity
2. (___) Sensitivity to cultural issues
3. (___) Reliable
4. (___) Organizing and Planning ability
Comments:
J. Interpersonal Characteristics: Overall Rating: __________
1. (___) Positive relationship with clients
2. (___) Positive working relationship with family of clients
3. (___) Positive working relationship with administrators
4. (___) Positive working relationship with professional staff
5. (___) Positive working relationship with clerical staff
6. (___) Positive working relationship with supervisor
7. (___) Respect for ideas and opinions of others
Please comment on the Practicum student’s strengths and weaknesses:
Strengths:
Weaknesses:
Overall Grade: _________________________________________________
Grade Supervisor Signature Date
A – Superior Performance W – Withdrawal
B – Satisfactory Performance I – Incomplete
C – Fair Performance NC – No Credit
F – Deficient Performance
Supervisor’s Signature Date
I have read and discussed this evaluation with my on-site supervisor.
Field Experience Practicum Student’s Signature Date
June,
2000
Form 8
Check One: Name:
__________________________
(___) Field
Experience Practicum I Cohort: _________________________
(___) Field Experience Practicum II
(___) Field Experience Practicum III Agency: ________________________
Agency’s On-Site Supervisor: ______________________________________
This form must be completed by Practicum student at the completion of each field experience Practicum term. One copy of this form is to be submitted to the Nova Practicum instructor and another copy to the Practicum Coordinator.
1–Few 2-Some 3-N/A* 4- Plenty 5-Alot
(*N/A means does not apply, or none)
(___) Clients with Chemical Dependency Problems as main presenting
complaint
(___) Clients with Gambling Problems as main presenting complaint
(___) Clients with Sexual Addiction Problems as main presenting complaint
(___) Clients with Dual Diagnosis Problems as main presenting complaint
(___) Clients with other types of additive impulse control problem as main
presenting complaint. Please describe:
(___) On ______ occasions, was able to apply information in clinical setting
gained from Practicum seminar (use rating scale above to complete sentence).
(___) Used Cognitive/Behavioral Therapy in therapy sessions
(___) Used Psychodynamic Therapy in therapy sessions
(___) Used Gestalt Therapy in therapy sessions
(___) Used Adlerian Therapy in therapy sessions
(___) Used other types of therapy in therapy sessions. Please describe:
(___) Amount of supervision received
(___) Usefulness of supervision received
(___) Supervisor available for consultation outside of supervision hour
Comments:
Field Experience Practicum Student’s Signature Date
1 copy to Nova Practicum Instructor
1 copy to Practicum Coordinator
June,
2000
Form 9
FIELD EXPERIENCE PRACTICUM
Consent for Audio
Tape Recording
I _______________________ consent to allow ______________________
Name of Client Name of Counselor
to tape record our counseling sessions. I understand this recording will be reviewed by my Practicum instructor from Nova Southeastern University to enhance my treatment. I also understand my case will not be discussed by any other person and the tape will be destroyed during or at the end of the semester.
I have read the above statement and have been given the opportunity to have all questions regarding the use of this recording to be answered to my satisfaction. I freely give my permission for one of my counseling session to be audio taped with the above named counselor.
Signature of Client Date
Witness Date
June,
2000
Form 10
EVALUATIONS:
˙ Midterm Due: ____________
˙ Final Due: ____________
˙ Practicum
Site Due: ____________
ASSIGNMENTS:
˙ Assignment
1 Due: ____________
˙ Assignment
2 Due: ____________
˙ Contact
Log Due: ____________
˙ Narrative
Report Due: ____________
˙ Treatment
Plan Due: ____________
˙ Tape
1 Due:
____________
˙ Tape
2 Due:
____________
SEMINAR DATES:
˙ 1.
__________ ˙ 5. __________
˙ 2.
__________ ˙ 6. __________
˙ 3.
__________ ˙ 7. __________
˙ 4.
__________ ˙ 8. __________
June,
2000