STUDENT/PRACTICUM/INTERNSHIP AGREEMENT

Directions: Student is to complete this form in duplicate and submit a copy of this agreement to the university practicum supervisor or internship coordinator.

1. I hereby attest that I have read and understood the American Psychological Association and the American Counseling Association ethical standards (Chapter 6 in this manual) and will practice my counseling in accordance with these standards. Any breach of these ethics or any unethical behavior on my part will result in my removal from practicum/internship and a failing grade, and documentation of such behavior will become part of my permanent record.
2. I agree to adhere to the administrative policies, rules, standards, and practices of the practicum/internship site.
3. I understand that my responsibilities include keeping my practicum/internship supervisor(s) informed regarding my practicum/internship experiences.
4. I understand that I will not be issued a passing grade in practicum/internship unless I demonstrate the specified  minimal level of counseling skill, knowledge, and competence and complete course requirements as required.

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Date