Additional Forms
        This page has several additional forms that you will need during your clinical experience. To obtain these forms clink on the link below, then copy and print them.
 
                                    NORTHEASTERN ILLINOIS UNIVERSITY
                                            COUNSELOR EDUCATION
                               CLINICAL EXPERIENCES SUMMARY OF HOURS
 

Name of Student: ________________________________  Semester/Year: __________

Name of Site: ___________________________________________________________

Name of Site Supervisor: __________________________________________________

Name of University Supervisor: _____________________________________________
 

                                                                         Practicum         Internship I        Internship II
__________________________________________________________________________
Direct Service Hours:
1. Individual Counseling                                     _________         _________         _________
2. Family Counseling                                          _________         _________         _________
3. Group Counseling                                          _________         _________         _________
4. Guidance Activities                                        _________         _________         _________
                                                      TOTALS     _________        _________         _________
              OVERALL TOTAL (Fall, Spring)                                  _________
                           OVERALL TOTAL (Fall, Spring, Summer)                                 _________

_____________________________________________________________________________
 
Supervision:
1.  Individual                                                        _________      _________         _________
2. Group                                                              _________      _________         _________
  TOTALS                                                           _________      _________         _________
  OVERALL TOTAL (Fall, Spring)                                              _________
  OVERALL TOTAL (Fall, Spring, Summer)                                                          _________

______________________________________________________________________________
 
Other:
1.  Include professional development,                    _________        _________         _________
     report writing at site, observation,
     etc., and other administrative duties.

 SEMESTER OVERALL HOURS                       _________        _________         _________
 OVERALL TOTAL (Fall, Spring)                                                  _________
 OVERALL TOTAL (Fall, Spring, Summer)                                                              _________

Students will submit 2 copies of this form at the end of each semester (1 to the university supervisor
and 1 to be included in the student file).  Retain a copy for self.
 

 
 
 














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