Spring 2022 SEMESTER DATES: 1/18/22 - 5/11/22
Your degree track determines how you are to fill out this form. Please read and complete carefully.
Please rank order your preferences for the following Internship sections (1-4):
Please make the course selections below according to your degree track. Select YES if you are currently enrolled in the course this semester.
Note: 2nd and 3rd term COUN 5389 Internship students do not need to turn in documents #1-3 below, but YOU DO NEED TO TURN IN THIS COMPLETED APPLICATION.
2.) Attach a copy of all Professional Counseling Performance Evaluations (PCPEs) given to you in all required experiential classes (5354; and one of the following: 5360, 5366, 5370, or 5373).
3.) Attach a 1-2 page statement of your counseling strengths and weaknesses.
If yes, please provide the following information:
Policies for acceptance into COUN 5389:
Note: Every internship student is required to submit the Memorandum of Agreement, Proposed Internship Activity Plan, and completed Supervisor Disclosure Statement to the Practicum/Internship Coordinator (Dr. Chiles) before the start of the Spring 2021 semester. These forms are NOT required to be turned in with this application.