Application for School Counseling Practicum/Fieldwork Placement
In submitting this application, I agree to the following:
-I will provide my Certificate of Clearance, my most current TB skin test, and Certificate of Mandated Reporting Training to Maricela Reyes in Human Resources. I understand I cannot begin my hours until I have been cleared by Human Resources;
-I understand that I will interview with the school counselors who are seeking an intern and if chosen will start my hours at that school;
-I will attend my practicum/fieldwork internships on dates agreed upon by my counselor supervisor;
-I will adhere to the ASCA National Model -a framework for school counseling programs as I engage in a broad and diverse range of activities;
-I will set a professional example of the Counseling Department in my relationships with people and in my dress code;
-I will respect confidentiality, legal and ethical codes when dealing with students , parents and staff.
First and Last Name *
Email Address *
Phone Number *
What university do you attend? *
What is the name of your university fieldwork supervisor? *
What is the phone number of your university fieldwork supervisor? *
What is the email of your university fieldwork supervisor? *
I am needing to complete
Clear selection
Do you need high school placement? *
If yes, how many hours?
Do you need middle school placement? *
If yes, how many hours?
What is the approximate date you would like to begin? *
What is the approximate date you are needing to complete your hours by? *
Are you a current SUHSD employee?
Clear selection
Anything else you would like for us to know?
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