The following are the agreement conditions for the NEIU Department of Counselor Education for

__________________________________ for clinical experience at ____________________
             (name of student)                                                                    (cooperating field site)

_______________________________________________ .  This clinical experience is in the
(street, city, zip)                          (telephone)

area of (school, community, family) counseling and comprises the (practicum - internships), which
               (please circle one)                                                          (circle one or both)

will beginning on (see below)______________  and end on ___________________________.

I.  NEIU Department  of  Counselor Education
     a. The Department of Counselor Education shall designate a faculty member who will serve as
         the university supervisor for field experience.
     b. The Department of Counselor Education will carefully select students recommended for field
         experience who have completed their core coursework toward their Masters Degree in
         counseling in methods and practice.
     c. Major responsibility for maintaining communications between the Department of Counselor
         Education and the field site rests with the practicum coordinator or university supervisor;
         however, the field site should initiate contacts when indicated.
    d.  The university supervisor conducts an on-going seminar for all students in field experience.
         Responsibility for the students' final grade rests with the university supervisor.
    e.  The assigned university supervisor will arrange periodic individual conferences with the students
         to focus on skill development and personal growth.
    f.   Northeastern Illinois University will provide liability insurance for the student while he or she
         is registered for the clinical experience. Any clinical experience that goes past the time limit
         will need to be reported to the clinical coordinator.

II.  The Field Site

    a.  The field site shall provide orientation for the student in regard to agency or school purpose,
         function and administrative procedures.
    b.  The field site shall be responsible for the assignment and administrative supervision of tasks
         within the students' capabilities which allow him/her to use and further develop counseling
         knowledge, attitudes, values, and skills. This will include a minimum number (see below to
         compute correct amount)of hours of direct work with clients, relationships with other staff
         and other agencies, and attendance at staff meetings,  and a minimum of clinical experience hours. 
    c.  The field site will provide space, equipment and supplies as needed by the student to carry out
         field site assignments. This should include clerical service for field site records if this service is
         provided for other staff.
    d.  The assigned field site supervisor will hold at least a master's degree in counseling or a closely
         related field with at least two years of professional experience in the field.
    e.  The field site supervisor will provide one hour of supervision per week for the students and be
         available for consultation as needed.
    f.  The field site will provide one midterm and one final written evaluation of the student's progress.
        Forms will be provided for this purpose.
    g.  The field site supervisor may meet with the university supervisor and student within the first few
         weeks of the semester to review expectations. Additional meetings can be scheduled as needed.
    h.  The field site is responsible for all the students work under their supervision.
    i.   The field site shall allow the student to use audio and/or televised taping of individuals or group
         counseling for purposes of supervision during the practicum with written permission of persons
         immediately involved.

Ill. The Student

    a.  The student shall assume responsibility for making and keeping his/her schedule with the field site.
         She/he is required to have a minimum of  clinical hours (see below) hours during the semester.
         He/she will be responsible for notifying the on-site supervisor and university supervisor of any
         emergency, anticipated absence or necessary schedule change.
    b.  The student shall assume responsibility in regard to; 1) the basic principles of counseling methods,
         especially the confidential nature of the work, 2) ethical behavior and relationships with the field
         site supervisor, fellow workers, clients, and community, and 3) appropriate dress and personal
         grooming.
    c.  The student shall complete records and assignments as required by the field site and the
         university supervisor.
    d.  The student shall assist in continuous planning for the experience through; 1) discussion with
         appropriate field site personnel, 2) discussion with university supervisor, 3) written evaluation
         at the end of the semester to be made available to the field site  (upon request) and the Department
         of Counselor Education

IV. General

    a.  Periodic conferences may be held between the university supervisor, coordinator and the
         appropriate field site personnel to evaluate the field experience, to implement improvements or
         to provide mutual assistance.
    b.  Any additions, deletions or other changes of this agreement can only be implemented with the
         written consent of the field site and Department of counselor education.
 
 

_________________________________________       ___________________________________
Student Signature                                    Date                             On-site Supervisor            Date

student e-mail ________________________                  ______________________________________
                                                                                                                    (Print name)

                                                                                     site supervisor e-mail___________________

_________________________________________   ___________________________________
Cooperating Field Site                    Date                              NEIU Coordinator                  Date
Official Title
 
 
 
 

Please download or make three copies of this form, one for the student, one for the field site, and one that is
returned with the appropriate signatures to the Clinical Coordinator.

note* Hours needed for school and community:
          Required hours for practicum are 100 total hours, of which 40 are direct clinical work.
          Required total hours for internships (both semesters combined) are 600 total hours, of which
          240 are direct clinical work.
          Students doing both practicum and internship at the same location may combine the hours into
          aggregate form, for 700 total hours, 280 of which are direct clinical work.
 
         Hours needed for family:
         Required hours for practicum are 100 total hours, of which 50 are face to face, with 16 hours of
         on-site supervision. Require total hours for internships (both semesters combined) are 600 hours
         total, of which 250 are face to face couple, family, group, and individual counseling, with 16 hours
         of on-site supervision per semester.  A cumulative 300 hours of face-to-face counseling is required,
         half of which are with an individual, and half are conjoint or family.  Students doing both practicum
         and internship at the same location may combine the hours into aggregate form, for 700 total hours,
         300 of which are direct clinical work.
 
         Clinical hours also include clinical supervision hours from university supervisor for both individual and
          group supervision for school, community and family students.
 
        Dates of Clinical Experience
        Practicums are one semester long and may be run during any semester. Internships are two semesters long.