Spring 2024 Internship 5389 Application

Rank Internship Sections

Spring 2024 SEMESTER DATES: 1/16/24 - 5/8/24

Your degree track determines how you are to fill out this form. Please read and complete carefully.

Applicant Name: *

Texas State ID (e.g. A########): *

Phone Number:

Email Addresses:

Texas State Email: *

Personal Email: *

Degree Track: *

Rank Internship Course

Please rank order your preferences for the following five Internship sections from 1 (first choice) to 5 (last choice).

COUN 5389.251 | TUESDAY, 12:30pm - 3:20pm | Round Rock | Dr. Cheryl Fulton *

COUN 5389.254 | MONDAY, 3:30pm - 6:20pm | San Marcos | Dr. Harriet Glosoff *

COUN 5389.255 | MONDAY, 6:30pm - 9:20pm | San Marcos | Dr. Tracy Chiles *

COUN 5389.256 | WEDNESDAY, 3:30pm - 6:20pm | San Marcos | Dr. Kathy Ybanez-Llorente *

COUN 5389.257 [SCHOOL TRACK**] | TUESDAY, 6:30pm - 9:20pm | Round Rock | Dr. Jennifer Greene-Roooks *

**School counseling interns are required to enroll in this section of internship and will have prior

COUN 5689 Clinical Practicum completion date, or anticipated date of completion: *

This will be my <i>X</i> semester of COUN 5389 Site-based Internship. *

Courses Completed

Indicate which courses you have completed for your degree track. Select YES if you have completed or are currently enrolled in the course this semester.

COUN 5301 - Professional Counseling Orientation

COUN 5305 - Assessment in Counseling

COUN 5307 - Theories of Counseling and Personality

COUN 5316 - Counseling Diverse Populations

COUN 5328 - Professional Orientation in School Counseling

COUN 5338 - Advanced Issues in School Counseling

COUN 5350 - Advanced Counselor Ethics

COUN 5351 - Current Issues in MCFC

COUN 5354 - Basic Counseling Skills

COUN 5355 - Career Counseling

COUN 5358 - Dynamics and Processes in Group Counseling

COUN 5359 - Psychopathology

COUN 5367 - MCFC Current Theories

COUN 5368 - Developmental Issues

COUN 5369 - Child and Adolescent Counseling Methods

COUN 5372 - Assessment and Treatment in MCFC

COUN 5391 - Research Methods

Elective: 3 hr

Which IM course (or courses) did you take?

COUN 5360 - IM MCFC

COUN 5366 - IM Adults

COUN 5370 - IM Adolescents

COUN 5373 - IM Play Therapy

COUN 5689 - Clinical Practicum

COUN 5389 - Internship 1

COUN 5389 - Internship 2

If there is any other information that needs to be considered with this application regarding section placement (e.g., enrolling in another course that interferes with a particular Internship section or Internship work schedule), you *MUST*** provide that information with this application.

Do not assume that the Internship Coordinator will be aware of individual concerns. **

Additional Information:

Required Documents:

^{Note: 2nd and 3rd term COUN 5389 Internship students do not need to turn in documents #1-3 below, but YOU DO NEED TO TURN IN THIS COMPLETED APPLICATION.}

1.) Attach a copy of your current Degree Audit or deficiency plan in PDF format (see CatsWeb) *

2.) Attach a copy of all Professional Counseling Performance Evaluations (PCPEs) given to you in all required experiential classes (5354; and one of the following: 5360, 5366, 5370, or 5373).

2-1.) Attach Basic Techniques PCPE (5354)

2-2.) Attach Intermediate Methods PCPE (5360, 5366, 5370, or 5373)

2-3.) Clinical Practicum PCPE (5689)

If you are currently enrolled in 5689 and do not yet have a PCPE, note instructor:

3.) Attach a 1-2 page statement of your counseling strengths and weaknesses.

This statement should incorporate your documented feedback on PCPEs. *

As of this date, have you been formally accepted at an Internship site?

If yes, please provide the following information:

Name of agency:

Agency Phone:

Agency Address:

Site supervisor’s name & credentials:

Site supervisor’s e-mail address:

Site Supervisors must hold one of the following credentials. Specify which credential your Site supervisor currently holds:

If you have not been formally accepted at a site, please list the internship sites you are currently considering:

Policies for acceptance into COUN 5389 Site based Internship:

Students in their second or third semester of 5389 have the highest priority.
Students who have completed the most coursework will have the next highest priority.
All supporting documents must be included with your application so that your needs can best be determined.
Order of receipt of application will also be used in assignment to course sections.

Start searching for internship sites as early in the previous semester as possible. All site supervisors must be approved prior to the start of the internship. Students cannot start an Internship semester without a secured Internship agreement.

Note: Every internship student is required to submit the Memorandum of Agreement, Proposed Internship Activity Plan, and completed Supervisor Disclosure Statement to the Practicum/Internship Coordinator (Dr. Chiles) before the start of the semester. These forms are NOT required to be turned in with this application.

If you happen to see this, do not fill this field.