[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-429812-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-429812-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","school-counseling-internship-student-information-approval-form","School Counseling Internship - Student Information Approval Form","","This document serves as the official Student Information Approval Form for the School Counseling Internship program at Xavier University. It requires prospective interns to provide comprehensive contact details, identify their site supervisor, and outline expected clinical experiences and clock hour requirements. The form mandates a two-part completion process: Part A involves student details and site information, while Part B requires the training supervisor to verify their professional credentials, licensing status, and provide a description of the supervision structure. By formalizing these arrangements, the university ensures that all internship placements meet the necessary educational standards and that supervisors are appropriately qualified to provide guidance. The final section requires supervisor validation of the supervisee's information, establishing a clear administrative link between the training site and the university's clinical coordinator to facilitate professional development and academic 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coordinator to request approval to begin the internship.  \nName:    \nAddress:    \nPhone: Work  Home   Semester:    \nSupervisor Name:   Title:    \nSchool name:    \nAddress:    \nPhone:    \nSupervisor Degrees/certification/licenses held:    \nBrief Description of Expected Experiences:    \n\n|  |\n| --- |\n|  |\n\nAnticipated Number of Clock Hours to Be Completed at this site:   hrs.  \nStudent Signature Date  \nApproved:   , Clinical Coordinator,    \n(Signature) (Date)  \nPART B: TO BE COMPLETED BY THE TRAINING SUPERVISOR  \nInstructions to supervisor:  \nAfter completing this form, please return it to the supervisee who is responsible for returning it to Xavier University.  \n1. Are you a licensed or certified as a School Counselor?  \n[ ] Yes [ ] No Grade Levels?   State?    \n2. If you are not a licensed school counselor, what license do you hold?    \n3. Please briefly describe the nature of the supervision to be provided:    \n4. Briefly describe your experience in training supervision    \n\n|  |\n| --- |\n|  |\n\n5. I HAVE REVIEWED THE SUPERVISEE’S STATEMENTS.  \nTHEY (ARE   ) (ARE NOT   ) ACCURATE","cbCaiaJvzTi6Fojw","https://ap.wps.com/l/cbCaiaJvzTi6Fojw","pdf",32006,"English","# School Counseling Internship Student Information Approval Form\n## Part A: Student and Site Information\n## Part B: Training Supervisor Verification","[{\"question\":\"What is the purpose of this form?\",\"answer\":\"This form is used to request approval from the Xavier University clinical coordinator to begin a school counseling internship.\"},{\"question\":\"Who is responsible for returning the completed form to the university?\",\"answer\":\"The supervisee is responsible for collecting the completed form from the training supervisor and returning it to Xavier University.\"},{\"question\":\"What information must the training supervisor provide in Part B?\",\"answer\":\"The supervisor must confirm their licensure or certification as a school counselor, provide details on their alternative licenses if applicable, describe the nature of the supervision provided, and outline their experience in training supervision.\"}]","School Counseling Internship - Student Information Approval Form | PDF",1790651254]