Internship Site Information Summary : Dept of Counseling, Leadership, Adult Education & School Psychology : Texas State University

Term

Intern Name: *

Phone Number:

Email: *

Internship Site Supervisor Name:

Supervisor Phone Number:

Supervisor Email:

Internship Site Name:

Internship Site Address:

Internship City:

Internship State:

Internship zip:

Internship Web Address:

Was your site:

Principle type of client's you saw at this facility:

Were you able to meet all your internship hours requirements?

Yes

No

Were you able to meet all your MCFC hours:

Yes

No

Please provide position title?

If school, for what district?

If school, for what campus ?

When faced with an ethnical or legal issue while at this site, how would you rate you overall support and guidance in resolving the issue.

Would you recommend this site to an on-coming counseling student?

Why?

Summary comments regarding your site:

COLLEGE OF EDUCATION