Forms, checklists, and manuals

EPS Practicum Laboratory Manual (Fall 2019)
Practicum Student Confidentiality Statement

Client file documents (for Lab)

• Authorization for Release of Information Form
• Case Review for Quality Assurance Checklist
• Informed Consent Agreement Form
• Intake Interview Report Form
• List of Clients Log
• Mental Status Behavioral Checklist
• Progress Notes Form
• Release & Exchange of Information Forms
• Request for (Families – Couples) Services Form
• Request for (Individuals) Services Form
• Session Rating Form
• Termination Summary Form
• Treatment Planning Form

As-Needed lab 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 Laboratory Confidentiality Statement
• 692 Hourly Log for CMHC Counselors-in-Training
• 692 Hourly Log for School Counseling Counselors-in-Training

Evaluation documents (completed by NAU Practicum Lab 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 Lab Students)

• (Field-Based) Counselor-in-Training Evaluation for Field-Based Practicum Experiences Form
• (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

Categories of forms, checklists, and manuals

New EPS graduate student orientation documentation

• Continuing Student Evaluation form
• New EPS Graduate Student Orientation Presentation – Fall 2015
• EPS Program Agreement Contract
• EPS Bookmark Document
• Graduate College 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.

• Currently closed; this application will open on January 2, 2020

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.

• Currently closed; this application will open on January 2, 2020

Student-EPS Program Agreement Contract

EPS Student Information Form

EPS 697 – Independent Study Guidelines & Form

EPS Student Professional Development Application

• Graduate Student Organization (GSO)
• COE Dean’s Graduate Research/Travel Grant Program Application

Continuing Student Evaluation Form 

• Professional Growth Plan (PGP) Form 

“Incomplete” Form

Travel related documentation

• TRAVEL POLICY CHANGES — EFFECTIVE FEBRUARY 1, 2017
• TRAVEL POLICY CHANGES — EFFECTIVE JULY 1, 2017
• Annual Travel Certification Form (electronic)
• EPS TRAVEL WORKBOOK 8-5-19
• EPS Travel Funding Request 8-13-19
• Non-Conference Travel Funding Request – Current
• COE Travel Expense Summary 7-31-18 Manual Version
• ROA Table – Current
• Current Meals and Lodging Cost Index (lower section of page)

Before Internship Begins:

1. CMHC Internship Manual & Syllabus
2. Sample of a Completed CMHC internship Contract
3. Step 1, Rough Draft of CMHC Internship Contract 
4. M.A. Counseling Internship Contract – Official electronic version

Throughout internship:

1. M.A. Counseling 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 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 Reflection Paper Rubric/Guideline (for interns)

Additional Intern forms:

1. Session and Outcome Rating Scales (SRS & ORS)
2. Multicultural and Social Justice Competencies

NAU Faculty Forms:

1. Faculty Supervisor Contact Form

Before Internship Begins:

1. EPS 694 – School Counseling Internship Manual (September 2015)
2. Internship timeline & checklist
3. M.Ed. School Counseling Internship Contract
4. Sample of a Completed School Counseling internship Contract

Throughout Internship:

1. M.Ed. School Counseling Internship Hourly Log

Mid-Point (before reaching 300 total hours):

1. Mid & Final Evaluation by School Supervisor and Student Self Evaluation
2. Intern Feedback for School Site at mid-point
3. Intern Feedback for School Supervisor at mid-point
4. Intern Feedback for NAU Faculty at mid-point
5. SC Reflection Paper Rubric (mid-pt)

Final (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 (final)
4. Intern Feedback for School Supervisor (final)
5. Intern Feedback for NAU Faculty (final)
6. SC Reflection Paper Rubric (final)

Additional Intern forms:

1. Session and Outcome Rating Scales (SRS & ORS)
2. Multicultural and Social Justice Competencies
3. State Certification Requirements 

NAU Faculty Forms:

1. Faculty Supervisor Contact Form

EPS Practicum Laboratory Manual (August 2012)

• 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 Laboratory Confidentiality Statement

EPS 608 – Student Affairs Fieldwork Handbook 

• 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 684 Student Affairs Internship Handbook

EPS 694 – Counseling 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

• EdS School Psychology Handbook (Fall 2016)
• Ed.S. School Psychology Handbook (April 2016)

• Combined Counseling/School Psychology Doctoral Student Handbook
• Combined Counseling/School Psychology Doctoral Practicum Handbook
• Combined Counseling/School Psyhcology Doctoral Student Checklist
• Intent to take Discipline Specific Knowledge (DSK) / Doctoral Comprehensive Examinations Form
  • The signed form must be submitted to the Educational Psychology Department by March 15 for the following Fall examination dates and October 15 for the following Spring examination dates.