Spring 2011 Prac-Intern Form
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The document is a student application for a practicum/internship in the Department of Counseling – Community Family Life Center at UTSA for Spring 2011. It requests student information, intended practicum site details, confirmation that prerequisites have been met, and the student's signature. If submitted by October 25, 2010, applicants will be notified via email of their application status and registration procedures.
Spring 2011 Prac-Intern Form
- 1. The Department of Counseling – Community Family Life Center Student Application for Practicum / Internship – Spring 2011 Please submit this application no later than Monday, October 25, 2010. Applicants will be notified via UTSA e-mail of their application status and procedures for registration after the deadline. STUDENT INFORMATION Student Name: Banner ID: Street Address: City: State: Zip Code: Home Phone: Cell Phone: UTSA E-mail: Academic Degree: M.A. Study Program: Course: Catalog of Admittance: 2003-2005 2005-2007 2007-2009 2009-2011 PRACTICUM / INTERNSHIP SITE INFORMATION Affiliated Site Name / Code: Phone: Fax: Specialization: Does this site allow students to audio or videotape for the purpose of supervision? Yes No PREREQUISITES Course Semester Grade Completed Received** Number Name COU 5203 Introduction to Community Counseling A B C D F or or COU 5103 Introduction to School Counseling A B C D F Child and Adolescent Counseling in a Systemic COU 5253 Context (i.e. school track only)* A B C D F COU 5213 Counseling Theories A B C D F COU 5223 Psychological Assessment for Counselors* A B C D F COU 5233 Group Theory and Process A B C D F Counseling Individuals with Behavioral & COU 5243 Emotional Disorders** A B C D F COU 5283 Counseling in Multicultural Setting A B C D F COU 5393 Development of Counseling Skills A B C D F COU 6153 Career Development & Choice* A B C D F EDU 5003 Research Methods in Education * A B C D F EDP 5033 Human Development Across the Life Span* A B C D F *Denotes courses that may be taken concurrently with practicum/internship for the 2007-2009 & 2009-2011 catalogs only. Students in all other catalogs must complete all courses listed above before being eligible to take practicum/internship. **COU 5243 can be taken concurrently with practicum for SCHOOL STUDENTS ONLY IN 2009-2011 catalog. **Please note: Only two “C”s are allowed on your program of study. APPLICANT CERTIFICATION Student Signature Printed Date Application for Practicum/Internship Page 1 Revised: 9/28/10