Forms, checklists, and manuals

EPS 697 and CPP 697 Independent Studies Instructions & Form

“Incomplete” form

Graduation Application Information (Graduation Application section)

New EPS EdS and Masters graduate student orientation documentation

• Professional Disposition Evaluation Form (PDE)
  • Professional Growth Plan (PGP) Form (PDF version)
  • Professional Growth Plan (PGP) Form (Word version)
• New EPS EdS and Masters Graduate Student Orientation Presentation
• EPS Program Agreement Contract
• EPS New Graduate Student Bookmark Document

Graduate assistantship

The Department of Educational Psychology graduate assistantship application due date is May 1.  Your application and curriculum vita or resume must both be received by that date to be considered for a department graduate assistantship position for the next academic year.  Please send your curriculum vita or resume to EPS@nau.edu.

• EPS Graduate Assistant Application (this link will reopen in January 2024)

Graduate scholarship (tuition waiver)

The Department of Educational Psychology graduate scholarship (tuition waiver) application due date is May 1.  Your application must be received by that date to be considered for a department graduate scholarship for any period within the next academic year.

• EPS Graduate Scholarship (Tuition Waiver) Application (this link will reopen in January 2024)

Student Professional Development Funding

EPS Student Professional Development Application
* Fall semester application due date:  September 15
* Spring semester application due date: March 1

Graduate Student Organization (GSO)

COE Dean’s Graduate Research/Travel Grant Program Application

Travel related documentation

• EPS Department Travel Workbook
• COE Travel Request Form 
• Annual Travel Certification Form (electronic)
• Current Meals and Lodging Cost Index (lower section of page)
• Post-Travel Itinerary
  • Sample EPS Travel Itinerary
• Post-Travel Mileage Log
• NAU Travel: Cost Comparisons Instructions

• Travel Policy
• Travel Training

Purchase or reimbursement related documentation

• EPS Department Non-Travel Purchase Instructions
• PS Public Purpose Rationale Table

Records Retention Schedule

• Records Management at NAU

EPS Practicum Clinic Manual (current)
Practicum Master Syllabus (rev. 2020)
Practicum Student Confidentiality Statement

Client file documents (for Clinic)

• All client file documents for the Clinic are available through our electronic health records (TherapyNotes)

As-Needed clinic documents

• Client Safety Plan
• No-Suicide Contract

Documents for practicum students’ notebooks

• Confirmation of Group Supervision Form
• Counseling Supervision Log
• Documentation of Observation Form
• Practicum Clinic Confidentiality Statement
• Hourly Log for CMHC Counselors-in-Training
• Hourly Log for School Counseling Counselors-in-Training

Evaluation documents (completed by NAU Practicum Clinic Faculty)

• Midterm/Final Counseling Practicum Counselor-in-Training Evaluation Form
• (Field-Based) Contract for Supervised Practicum Experiences Conducted In-the-Field
• Faculty Evaluation Case Staffing Reflection Paper, completed at mid-term and end-of-semester

Evaluation documents (completed by Field Supervisor) 

• 692 Field Supervisor’s Evaluation of Practicum Student (End of Practicum only, 2019 – on)

Evaluation documents (completed by Practicum Clinic Students)

• (Field-Based) Counselor-in-Training Evaluation of Site Form
• (Field-Based) Counselor-in-Training Evaluation of Site Supervisor Form

Recruiting clients

• Class Credit Form
• Free Counseling Form

Before Internship Begins:

1. Before an internship can begin, there must be an NAU Affiliation Agreement in place. This is required per NAU Policy on Affiliation Agreements. Please review this document for further information regarding Affiliation Agreements and instructions for how to set-up an Affiliation Agreement with your desired Internship site.
2. CMHC Internship Manual & Syllabus
3. Sample of a Completed CMHC internship Contract
4. Step 1, Rough Draft of CMHC Internship Contract 
5. M.A. Counseling Internship Contract – Official electronic version
6. NAU’s Internship Coverage Statement (in addition to the required individual liability all Practicum and internship students must carry)

Before Internship Begins – Supervisor Orientation, Consultation & Professional Development

1. Site Supervisor Orientation Video #1
2. Site Supervisor Orientation Video #1 Handout 
3. Site Supervisor Orientation Video #1 Quiz
4. (Recommended, but not Required) Site Supervisor Training Video #2 – Goodyear’s Feedback Informed Supervision 
5. One Free Continuing Education Unit (CEU) for Site Supervisors: Case Conceptualization Via Integral Theory
   1. Video
   2. Brief 1-CEU quiz covering Integral Supervision video

Throughout internship:

1. M.A. CMHC Internship Hourly Log

Mid-Point (before reaching 300 total hours):

1. CMHC mid-point and final Evaluation by Site Supervisor and Student
2. Intern Feedback for Agency Site (mid-pt)
3. Intern Feedback for Agency Supervisor (mid-pt)
4. Intern Feedback for NAU Faculty (mid-pt)
5. CMHC Reflection Paper – Faculty Scoring Link (mid-pt)
6. CMHC Faculty Link for First Contact 
7. CMHC Faculty Link for Second Contact 
8. CMHC Faculty Link for Third Contact 
9. CMHC Reflection Paper Rubric/Guideline (for interns)

Final (Near the end of internship – just before reaching 600 total hours):

1. CMHC mid-point and final Evaluation by Site Supervisor and Student
2. Intern Feedback for Agency Site (final)
3. Intern Feedback for Agency Supervisor (final)
4. Intern Feedback for NAU Faculty (final)
5. Agency Supervisor End of Internship Program Evaluation Form (final)
6. CMHC Reflection Paper – Faculty Scoring Link (final)
7. CMHC Faculty Link for First Contact 
8. CMHC Faculty Link for Second Contact 
9. CMHC Faculty Link for Third Contact 
10. CMHC Reflection Paper Rubric/Guideline (for interns)

Additional Intern forms:

1. Multicultural and Social Justice Competencies

Before Internship Begins:

1. Before an internship can begin, there must be an NAU Affiliation Agreement in place. This is required per NAU Policy on Affiliation Agreements. Please review this document for further information regarding Affiliation Agreements and instructions for how to set-up an Affiliation Agreement with your desired Internship site.
2. School Counseling Internship Manual (March 2022)
3. Internship timeline & checklist
4. M.Ed. School Counseling Internship Contract
5. Sample of Completed School Counseling Internship Contract

Supervisor Orientation, Consultation & Professional Development

1. Video #1: Overview of NAU’s School Counseling Internship, expectations and evaluation forms
2. Video #2: Overview of Supervision Models and Methods 
3. Video #3: One Free Continuing Education Unit (CEU) for Site Supervisors: Case Conceptualization Via Integral Theory
   1. Brief 1-CEU quiz for Integral Supervision video
4. Site Supervisor Orientation Quiz

Throughout Internship:

1. M.Ed. School Counseling Internship Hourly Log

Mid-Point Evaluations (before reaching 300 total hours):

1. Mid & Final Evaluation by School Supervisor and Student Self Evaluation
2. Intern Feedback for School Site
3. Intern Feedback for School Supervisor
4. Intern Feedback for NAU Faculty
5. SC Reflection Paper Rubric

Final Evaluations (Near the end of internship – just before reaching 600 total hours):

1. Mid & Final Evaluation by School Supervisor and Student Self Evaluation
2. School Supervisor End of Internship Program Evaluation Form
3. Intern Feedback for School Site
4. Intern Feedback for School Supervisor
5. Intern Feedback for NAU Faculty
6. SC Reflection Paper Rubric

Additional Intern Resources:

1. ASCA Professional Standards & Competencies
2. ASCA Mindsets and Behaviors
3. Multicultural and Social Justice Competencies
4. State Certification Requirements 

NAU Faculty Forms:

1. Faculty Supervisor Contact Form

EPS Practicum Clinic Manual (Spring 2017)

• Authorization for Release of Information Form
• Case Review for Quality Assurance Checklist
• Class Credit Form
• Confirmation of Group Supervision Form
• Counseling Supervision Log
• Documentation of Observation Form
• EPS Counseling Psychology Doctoral Practicum Evaluation Form
• Free Counseling Form
• Informed Consent Agreement Form
• Intake Interview Report Form
• List of Clients Log
• Mental Status Behavioral Checklist
• No-Suicide Contract
• Progress Notes Form
• Request for (Families – Couples) Services Form
• Request for (Individuals) Services Form
• Session Rating Form
• Termination Summary Form
• Treatment Planning Form
• Practicum Clinic Confidentiality Statement

EPS 608 Student Affairs Fieldwork Handbook (11-20-19)

• Student Affairs Fieldwork Contract
• Student Affairs Fieldwork Faculty Supervisor Contact Form
• Student Affairs Fieldwork Student Evaluation Form
• Student Affairs Fieldwork Student Evaluation of Faculty Supervisor Form
• Student Affairs Fieldwork Student Evaluation of On-Site Supervisor Form
• Student Affairs Fieldwork Student Evaluation of Site Form
• Student Affairs Fieldwork Weekly Narrative Reflection Form

EPS 682 Student Affairs Practicum (Internship) Handbook

• M.Ed. Student Affairs Internship Contract
• Evaluation of Student’s Internship Experiences
• Faculty Supervisor Contact Form
• Intern Evaluation of NAU Faculty
• Intern Evaluation of On-Site Supervisor
• Intern Evaluation of Site

• Ed.S. School Psychology Handbook (Fall 2016)
• Ed.S. School Psychology Handbook (April 2016)
• Ed.S. School Psychology Handbook (Summer 2020)
• Ed.S. School Psychology Handbook (Spring 2021)
• Ed.S. School Psychology Handbook (Spring 2022)

• Combined Counseling/School Psychology Doctoral Student Handbook
• Combined Counseling/School Psychology Doctoral Practicum Handbook 
• Combined Counseling/School Psychology Doctoral Student Checklist
• Intent to take Discipline Specific Knowledge (DSK) / Doctoral Comprehensive Examinations form
• NAU PhD Practicum and Fieldwork Midpoint & Final Evaluation