The College of New Jersey

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Clinical Forms

Required Paperwork to begin Practicum / Internship experience (April1 deadline for starting Practicum in the Fall semester and December 1 deadline for starting Practicum in Spring semester)

Clinical Mental Health Site Approval Form

Clinical Site Approval Request Form – Marriage, Couple, & Family Counseling & Therapy

School Counseling Site Approval

SAC Internship Site Approval Form

Clinical Site Agreement Form – Educational Specialist Degree in Marriage and Family Therapy

Site Supervisor Agreement Form

Site Supervisor Vita

Practicum Paperwork Requirements

Request for Site Letter Form

Change of Site Form


Consent for Digital Video- / Audio-recording 

Consent Form for Individual Supervision

Consent Form for Individual and Group Supervision


Practicum and Internship Activity Logs

Practicum Activity Log: PDF

Internship Activity Log: PDF

Practicum Activity Log for MCFCT students: PDF

Internship Activity Log for MCFCT students: PDF

Supervision Form and Evaluations

Practicum Evaluations

Practicum Evaluation of Counselor – On Campus Individual Supervisor

Practicum Evaluation of Counselor – Site Supervisor


End of Semester Internship Evaluations

Supervisor’s Evaluation of Counselor-Clinical Mental Health Counseling

Supervisor’s Evaluation of Counselor-Community Counseling

Supervisor’s Evaluation of Counselor-Marriage, Couple & Family Counseling & Therapy

Supervisor’s Evaluation of Counselor-School Counseling

Supervisor’s Evaluation of Counselor-Student Assistance Coordinator (SAC)


Weekly Supervision Session Log (for On Campus and On Site Supervision) – with Cover page/Directions

Weekly Supervision Session Log (for On Campus and On Site Supervision) – without Cover page (to make copies for additional weeks of supervision session logs)


Student Evaluation of Supervisor


Guidelines for K-12 Comparative Analysis or Agency-Organizational Analysis

K-12 Comparative Analysis

Agency-Organizational Analysis


Internship Conclusion Evaluations

Student Evaluation of Clinical Site

Evaluation of Clinical Program by Site Supervisor


Requirement of Professional Liability Insurance

Students who plan on starting Practicum in the Spring 2011 or afterwards are required to obtain their own professional liability insurance in addition to the coverage provided through the College and/or his/her placement.  A copy of the student’s certificate of insurance needs to be submitted to his/her Practicum or Internship course instructor at the beginning of the semester and when the student renews his/her professional liability insurance.  While the Department requires students to purchase professional liability insurance to adhere to the best practice, it should be noted that it is a rare occurrence that would require the protection provided by professional liability insurance.

The Department suggests membership in American Counseling Association (ACA) and enrollment in the professional liability insurance plan that is available to all ACA graduate student members.  For the students in School Counseling Program, American School Counselor Association (ASCA, a division of ACA) also offers the professional liability insurance plan. Similarly, the students in Marriage, Couple and Family Counseling and Therapy Program may obtain a professional liability insurance through membership in American Association for Marriage and Family Therapy (AAMFT).  Each student will need to evaluate the clinical site to determine which professional liability insurance is appropriate.  Student membership benefits for ACA, ASCA, or AAMFT can be found in its respective website,,, or