Draw up a typed contract that explicitly describes the agreement between you the student, the supervisor, and site,
Student’s name, address, and telephone number
The name, address and telephone number of the site
The clinical supervisor’s name and credentials
The contact person for the site, if different from the supervisor
The time commitment per week/per semester by the student
The supervision commitment by the supervisor
Onsite Fieldwork Contract
Home Phone:
Work Phone:
Phone Number:
Contact person:
hours of counseling-related
during the
. During this time,
. I
will observe therapy, do co- therapy, and do individual, group, and family therapy on my own as directed by
my supervisor, Supervisor's Name: . I also agree to be available to help with any
other therapy-related or educationally relevant experiences that would be helpful within the constraints of
hours. In all of my work, I will observe the established policies and procedures of the Site's
I, Supervisor's Name:
, agree to supervise Student's Name: approximately
1 hour of individual supervision per week during the period between DD/MM/YY:
and DD/MM/YY: . I will meet the responsibilities of a clinical supervisor as
outlined in the “Clinical Supervisor Responsibilities” form. This includes meeting one hour face-to-face per
week, regardless of hours Student's Name:
will try to structure Student's Name:
has spent with clients. To the degree that I am able, time
so that he will have a minimum of 150 hours of
face contact with clients. I understand that this contact can include co-therapy, individual, group, and/or family
. In addition, I will support Student's Name:therapy done by Student's Name: in
conducting two (Internship) taped sessions or provide & document live supervision. I will complete periodic
evaluations of Student's Name: and, after discussing it with him, will submit the original into
LiveText. I am aware that I will communicate with the faculty supervisor periodically. I understand that the
faculty member will provide John with group supervision an average of 1.5 hours per week.
I confirm
this site is a traditional counseling site as defined in the Practicum/Internship Manual and
Supervisor Name Date
Student Name
Counselor Education and Supervision, PhD Internship
I, Student's Name: agree to provide approximately 200
services as a Doctoral-level fieldwork student at the Site's Name:
four-month period between DD/MM/YY: and DD/MM/YY:
I agree to become familiar with the policies and procedures of the Site's Name: