Practicum and Internship
Clinical Mental Health Counseling &
Marriage, Couple, and Family Counseling
Practicum (CNS 591) and Internship (CNS 596)
Resources
Practicum and Internship Manual (CMHC & MCFC) 
Approved Practicum & Internship Sites - Counseling Job Opportunities
Required Clinical Paperwork
Please follow the directions for completing and submitting the form in PDF.
- Practicum Portfolio Checklist
- Internship Portfolio Checklist
- Practicum Application Form
- Practicum Site and Supervision Contract
- Internship Site and Supervision Contract
- Practicum/Internship Hour Log
- Practicum Evaluation of Student Performance (Midterm and Final)
- Practicum Counseling Skills Scale
- Internship Evaluation of Student Performance (Midterm and Final)
- Student Evaluation of Supervisor
- Student Evaluation of Site
- Sample LPCA Application
The full LPCA application also requires official transcripts, a signed supervisory agreement, KY & FBI background checks, and payment (these are not required for the internship portfolio). Visit lpc.ky.gov for more details.
Additional Paperwork
- Permission to Video
- Sample Client Intake Form & Case Notes (SOAP format)
- Plan of Action for Course Completion
- Petition for Change in Practicum or Internship Site
- Transcript
Establishing and Maintaining Clinical Sites
Review the Practicum & Internship Manual for instructions on establishing a new site or maintaining a clinical site. The following are forms used for reviewing and updating sites annually:
- Site Information Form (form should be saved first and then completed in Adobe Reader or Pro)
- Site Visit Checklist
Related Departmental Policies
- CSA Policy on Security of Media (Video and Audio)
- Practice Preparation Sequence and Departmental Approval for Practicum and Internship Placement Policies
- Internship Grading
Directions for working with the Forms
- Right click on the link above and choose "save as," and save the file to your computer.
- Open the file you want to print or edit and modify if desired. After editing the file, save it.
- Attach it to email, print it, or save it for future editing.
- To view PDFs, you can download Adobe Reader free by going to http://get.adobe.com/reader/.
- To create PDF files, you can download CutePDF for free at http://www.cutepdf.com/.
Dates & Deadlines
2016-2017 Practicum & Internship
- Mar 10, 2017: Submit mid-term evaluations to faculty supervisor for review and signature. Submit signed evaluations to Clinical Coordinator.
- May 5, 2017: Submit all final signed paperwork (see Internship Portfolio Checklist) to your Faculty Supervisor and the Clinical Coordinator. Contact CC if an extension is required. Must be submitted no later than 5/12/17.
2017-2018 Practicum & Internship
- May 1, 2017: Submit the Practicum Site and Supervision Contract.
- May 15, 2017: Begin practicum.
- Jul 7, 2017: Submit mid-term evaluations to faculty supervisor for review and signature. Submit signed evaluations to Clinical Coordinator.
- Aug 11, 2016: Submit all final signed paperwork (see Practicum Portfolio Checklist) to your Faculty Supervisor for review and signature. Submit signed evaluations to Clinical Coordinator.
- Aug 14, 2017: Submit the Internship Site and Supervision Contract if changing sites.
- Aug 21, 2017: Begin internship.
- Oct 13, 2017: Submit mid-term evaluations to faculty supervisor for review and signature. Submit signed evaluations to Clinical Coordinator.
- Dec 1, 2017: Submit all final signed paperwork (see InternshipPortfolio Checklist) to your Faculty Supervisor for review and signature. Submit signed evaluations to Clinical Coordinator. Contact CC in advance if an extension is required; portfolio must be submitted no later than 12/8/17.
2018-2019 Practicum & Internship
- Feb 2018, 3:00-5:00pm: Attend the mandatory practicum orientation.
- Feb 2018, 3:00-5:00pm: Attend the Internship & Job Fair to learn more about potential practicum sites. Sites can register online; students do not need to register.
- Mar 1, 2018: Submit the Practicum Application Form. You must get this form approved by the Clinical Coordinator BEFORE you apply for a practicum site to verify your eligibility to enroll in practicum.
- May 1, 2018: Submit the Practicum Site and Supervision Contract.
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