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:
I, Student's Name: agree to provide approximately hours of counseling-related
services as a Doctoral-level fieldwork student at
the Site's Name:
and MM/DD/YY:during the four-month period between MM/DD/YY: .
During this time, I agree to become familiar with the policies and procedures of the Site's
. 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 the hours. In all of my work, I
will observe the established policies and procedures of the Site's Name:
, agree to supervise Student's Name:
approximately 1 hour of individual supervision per week during the period
I, Supervisor's Name: a
between MM/DD/YY: and MM/DD/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:
h as spent with clients. To the degree that I am able, I will try to structure Student's Name: t
time so that he will have a minimum of 40 hours of face-to-face contact with clients. I
understand that this contact can include co-therapy, individual, group, and/or family therapy done by
Student's Name:
In addition, I will support Student's Name: in conducting three
(Practicum) 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 Handbook.
Supervisor Name Date Student Name Date
Counselor Education and Supervision Practicum