Counseling Practicum and Mental health Counseling Internship Forms and Documents

• Counseling Practicum and Internship Handbook
• Practicum and Internship Application
• OCESS Background Check
• OCESS Tuberculosis Test
• Practicum and Internship Site Agreement

710C, 793C and 794C Practicum and Internship Course Documents (MHC)

• Counseling Practicum and Internship Handbook
• Mental Health Counseling Handbook
• Practicum and Internship Counseling Log
• EXAMPLE Practicum and Internship Counseling Log
• Supervision Notes Form
• Supervision Attendance Log
• EXAMPLE Supervision Attendance Log
• Counseling Skills and Techniques Competency Scale Evaluation
• Graduate Students Graduation Application

Professional School Counseling Internship Forms and Documents

*Please fill out all form(s) in its entirety. No form will be processed if all the required fields are not completed. EMAIL the completed forms to your advisor.

*Please contact the Office of Clinical Experience and Student Services (OCESS) at 757-823-8715 or mdjones@nsu.edu for additional information about forms and payment needed in order to process your background check. 

• OCESS Internship Application
• OCESS Background Check
• OCESS Background Check Money Order Template
• OCESS Initial Placement Application
• OCESS Tuberculosis Test
• House Bill One Waiver
• COVID-19 Acknowledgement of Risk Form

*Please select the school district in which you would like to intern.

• Chesapeake Public Schools Field Experience Request Form
• Norfolk Public Schools Field Experience Request Form
• Suffolk Public Schools Field Experience Request Form
• Virginia Beach Public Schools Network Agreement Form
• Virginia Beach Public Schools Student Teaching Guidance Request Form
• Hampton Public Schools 40 Hours or more Addititional Fingerprinting and TB Proof
• Newport News Public Schools Background Check Information

793 and 794 Internship Course documents (PSC)

• Counseling Practicum and Internship Handbook
• Professional School Counseling Handbook
• Internship Agreement
• Internship Plan
• Direct and Indirect Definition of Terms for Time Sheet
• Internship Time Log
• EXAMPLE Internship Time Log
• Interim First Evaluation
• Internship Site Supervisor Final Evaluation PART I
• Internship Site Supervisor Final Evaluation PART II
• Graduate Students Graduation Application